P106 | What’s in a lymph node? A case of unexplained fever and lymphadenopathy
C. Moressa1, S. Sciacca2, G. Palamà1, E. Palaghita1, G. Romano1, M. Giusti3 | 1Università degli Studi di Torino, Scuola di Specializzazione in Medicina Interna, MIC2 Ospedale San Giovanni Bosco, Torino, 2ASL Città di Torino, Dirigente Medico in MIC2 Ospedale San Giovanni Bosco, Torino, 3ASL Città di Torino, Direttore di Dipartimento Area Medica, Direttore di Struttura Complessa in MIC2 Ospedale San Giovanni Bosco, Torino, Italy
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Background: Internal Medicine deals with complex cases, frequently with nonspecific presentation, and Fever of Unknown Origin is one of the hardest challenges.
Clinical case: A 56-year-old woman came to the ER for persistent hyperpirexia unresponsive to two lines of antibiotics, associated with right inguinal painful lymph node. In her medical history, a psoriatic arthritis treated with methotrexate and adalimumab, and NDD thrombocytopenia. Suspecting an infectious disease, she was investigated for common and opportunistic pathogens, zoonosis and STDs, without significant findings. A gynecological evaluation ruled out PID, transthoracic echocardiogram excluded vegetations, and total body CT confirmed inguinal lymphadenopathy and splenomegaly: only the hypotheses of lymphomatous disease or rare causes remained open. The patient underwent excisional lymph node biopsy, showing subsequent clinical improvement. Although the evolution seemed to lead to a diagnosis of Castleman’s disease, the histological examination was diagnostic for follicular T Helper lymphoma with angioimmunoblastic phenotype. Therefore, the patient was treated with chemotherapy following the CHOEP regimen. A follow-up CT performed after two months showed stable splenic disease, without captating lymph nodes. The patient continued through the oncohematological pathway aimed at marrow transplantation.
Conclusions: Angioimmunoblastic T cell lymphomas typically present with nonspecific symptoms; deductive reasoning can help to reach an early diagnosis, thus increasing the possibility of a favourable clinical evolution.
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