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Immunoblastic Lymphadenopathy Patient With Prolonged Fever of Unknown Origin

Brendan K. MacDougall, MD, FRCP(C); Brian H. Weinerman, MD, FRCP(C)
JAMA. 1979;241(9):921-922. doi:10.1001/jama.1979.03290350041021.
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IMMUNOBLASTIC lymphadenopathy, first described by Lukes and Tindle1 in 1973, is characterized by fevers, sweats, weight loss, rash, pruritus, lymphadenopathy, and hepatosplenomegaly. Other features include hypergammaglobulinemia, hemolytic anemia, positive Coomb's reaction, and a history of drug hypersensitivity. We recently saw a patient with a ten-month history of recurrent fever of unknown origin in whom multiple cultures, lymph node biopsy specimens, and a laparotomy were initially nondiagnostic.

Report of a Case  A 36-year-old woman was admitted to the hospital on April 6, 1975, with a one-week history of fever, shortness of breath, and general malaise. She was acutely dyspneic and febrile (39 °C) and had bibasilar rales but no lymphadenopathy, hepatosplenomegaly, or skin rash. Her hemoglobin level was 12 g/dl, and her WBC count was 9,500/cu mm, with 91% polymorphonuclear leukocytes, 7% lymphocytes, and 2% eosinophils. The liver enzyme levels were normal. The initial chest roentgenogram showed a moderately


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