Wednesday, May 28, 2008


Patient is a 68 year old African American woman with a history of non-Hodgkin's lymphoma treated with chemotherapy and radiotherapy in 1980.

Symptoms now: she has type-B symptoms only - sweats at night, lost 14 pounds in the last 2 months, 7 pounds in the last 1 month. Low appetite also. There are no respiratory symptoms at all.
She also has burning feeling in the feet
She has right hilar and subcarinal adenopathy; she also has gastrohepatic and periportal adenopathy and slightly more prominent intrahepatic biliary tree dilatation with slightly more dilatation of the previously dilated common bile duct.

A surgical excision biopsy of an axillary node showed non-caseating granulomatous inflammation with no lymphoma at all.

Again her symptoms are as above - some B symptoms and a likely peripheral neuropathy (I think).

How would you approach this patient next?

6 comments - CLICK HERE to read & add your own!:

Anonymous said...

it would be useful to see the labs.lymphoma still very much on the table.Maybe sample the abdominal nodes with laparoscopy..

Anonymous said...

PET scan

Anonymous said...

opportunistic organism comes to mind especially since she may be immunocompromised. Nite sweats, weight loss, make me think goold old fashioned TB or atypical

circle r

PMHayes said...

I tend to agree with the opportunistic organism idea. Her immune system has to have taken a pretty big hit, given the pounding her body has taken. Seems that more and more this problem is raising it's ugly little head. We even see it in pediatrics, kids who have spent more days sick than well for years presenting with some pretty nasty necrotizing pneumonias

Anonymous said...

Refer to her MD

ilir said...

Labs would be useful in this case.Infection seems probable and those symptoms may be compatible with TBC.To consider again lymphoma also.