Question 57

Question:

A 34-year-old woman presents to her general physician with a nonspecific fever of five days duration. She says that there are swollen “bumps” in her right axillary region which are painful. She complains of fatigue, low-grade fever, and some stomach pain. Physical exam reveals tender right axillary lymphadenopathy. She also has a minor laceration on her right forearm that her cat gave her a week ago. She admits to a 5 kg weight loss but says she is not hungry. What findings are likely to be prominent if a biopsy was performed of a right axillary lymph node?

Correct Answer: A.  Prominent germinal centers

This patient is most likely suffering from “cat-scratch disease”, a bacterial infection caused by Bartonella henselae. This unilateral lymphadenopathy on the side of the scratch combined with nonspecific constitutional symptoms is characteristic of the disease. The patient thus likely has an expansion of germinal centers, which are aggregates of B cells that can occur upon antigen presentation.

Effacement of nodal architecture (B) is characteristic of lymphoma, especially Hodgkin lymphoma in a female patient of this age.

Proliferation of cytotoxic CD8 T cells (C) can occur during a delayed hypersensitivity reaction to antigens such as tuberculosis.

Atypical lymphocytes (D) are characteristic of infection with Ebstein-Barr Virus or cytomegalovirus.

Numerous band cells (E) are more common in acute septic infections such as those by pneumococcus.