title: Infectious lymphadenitis in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma: a rare, but important, complication.
abstract: The differential diagnosis of rapidly progressive or symptomatic lymphadenopathy in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) includes infectious lymphadenitis. We studied 286 (9%) of 3040 patients with CLL seen between 2003 and 2012 at Mayo Clinic Rochester who had 356 diagnostic lymph node biopsies to evaluate rapidly progressive or symptomatic lymphadenopathy. Most (85.4%) biopsies showed progressive CLL, 8.9% a second lymphoid malignancy, 3.9% infectious lymphadenitis, 1.1% reactive adenitis and 0.6% non-hematological malignancies. Of the 12 patients (14 biopsies) with infectious lymphadenitis, five patients had never been treated for their CLL, and seven had a specific microbiological diagnosis (herpes simplex n=3, Cryptococcus neoformans n=1, Mycobacterium n=1, coagulase negative Staphylococcus n=2). We conclude that infectious lymphadenitis is a rare complication of CLL with clinical characteristics similar to progressive CLL and transformation to a more aggressive lymphoma. Early recognition and antimicrobial therapy treatment of infectious lymphadenitis can be highly effective in these patients.
authors.affiliation: Division of Hematology.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Bowen
authors.forename: Kari G
authors.initials: KG
authors.lastname: Rabe
authors.forename: Susan M
authors.initials: SM
authors.lastname: Schwager
authors.forename: Susan L
authors.initials: SL
authors.lastname: Slager
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Call
authors.forename: David S
authors.initials: DS
authors.lastname: Viswanatha
authors.forename: Clive S
authors.initials: CS
authors.lastname: Zent
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis*; D008199:Lymphadenitis / Q000175:diagnosis* / Q000382:microbiology / Q000821:virology; D008297:Male; D008875:Middle Aged
keywords: CLL; Chronic lymphocytic leukemia; Cryptococcus; Mycobacterium avium; herpes simplex; infection; lymphadenitis; lymphadenopathy; small lymphocytic lymphoma