ankylosing spondylitis and swollen supraclavicular lymph node

ANKYLOSING SPONDYLITIS AND SWOLLEN SUPRACLAVICULAR LYMPH NODE SKIN

PCR (using primers to the major HSV glycoprotein, g8, at the University of Washington Medical Center) and culture (using fluorescent antibody) confirmed the presence of HSV-2. Electron microscopy ( figure 2C) revealed intranuclear and intracytoplasmic virus particles morphologically consistent with herpesvirus. Immunohistochemical stains using polyclonal antibodies against HSV-1 and HSV-2 virus, respectively, were positive ( figure 2B, only to HSV-2 shown). Histological examination of the biopsy material revealed necrotizing lymphadenitis consistent with herpetic lymphadenitis ( figure 2A). An excisional biopsy of a left supraclavicular lymph node was performed. Routine urine, sputum, and blood cultures were negative, as were mycology and mycobacterial cultures. Serologic tests for HIV, syphilis, coccidioides, histoplasmosis, cryptococcosis, toxoplasmosis, Bartonella henselae, brucellosis, Epstein-Barr virus, and cytomegalovirus were negative. Right, Appearance after 18 months of acyclovir and intravenous immunoglobulin (a full-color version is available in the on-line edition of this article). An abdominal CT scan again showed marked splenomegaly, para-aortic lymphadenopathy, and a 1.5-cm left adrenal mass. Pulmonary function tests demonstrated obstructive and restrictive lung disease with a markedly reduced diffusion capacity. A CT scan of the chest showed bilateral interstitial lung disease with fibrosis at the bases. A CT scan of the neck revealed extensive soft-tissue swelling and multiple rim-enhancing masses in the left cervical region extending from the inferior portion of the left parotid gland to the supraclavicular level, consistent with necrotic lymph nodes or multiple abscesses. The remainder of the examination was noteworthy for the presence of a firm, tender, 2-cm × 2-cm left axillary lymph node, firm, 1-cm inguinal lymph nodes bibasilar dry crackles on lung examination, and hepatosplenomegaly. Palpation of the mass revealed markedly indurated, hard, fixed, and matted submandibular and cervical lymph nodes. Physical examination revealed a temperature of 37.7☌ a warm, erythematous, tender neck mass was noted to extend from the left lower mandible to just below the pinna to the base of the neck ( figure 1A).

The patient was then admitted to our hospital in July of 1996 for progressive enlargement of the neck mass. The patient defervesced spontaneously and was discharged home.

ANKYLOSING SPONDYLITIS AND SWOLLEN SUPRACLAVICULAR LYMPH NODE SKIN

Delayed type hypersensitivity skin test was reactive to mumps. Blood, mycobacterial, and mycology cultures were sterile. An MRI scan of the neck revealed massive anterior and posterior cervical lymphadenopathy, with displacement of the trachea and left carotid artery. In June 1996, the patient was readmitted with fever of 38.9☌, chills, and night sweats. The patient's cervical lymphadenopathy increased in size over 2 months. A bone marrow biopsy revealed a single cluster of lymphohistiocytes, with no evidence of lymphoma. An excisional biopsy of the left neck mass performed at an outside hospital revealed a dense mass of matted lymph nodes, with histologic evidence of lymphoid infiltration of the sternocleidomastoid muscle with central necrosis and surrounding reactive hyperplasia culture results were negative for bacteria, mycobacteria and fungi. CT scan of the abdomen showed hepatosplenomegaly and abdominal and para-aortic lymphadenopathy. CT scan of the neck was obtained, revealing bilateral cervical and left submandibular lymphadenopathy. The patient first noted the neck swelling in April 1996. He had a history of chronic sinusitis, otitis media, chronic interstitial lung disease diagnosed by open lung biopsy, cataract of the right eye secondary to herpes zoster infection 3 years prior, recurrent genital herpes, and treated syphilis. Case ReportĪ 43-year-old male flight attendant was admitted to Harbor-UCLA Medical Center in July 1996 with an enlarging left neck mass associated with fevers, chills, night sweats, and a weight loss of 25 lbs. The following case report describes a patient with common variable immunodeficiency (CVID), natural killer (NK) cell deficiency, and massive cervical lymphadenopathy in response to infection with HSV.

Lymphadenopathy in HSV infection may occur in association with disseminated infection with multiorgan involvement, as generalized lymphadenopathy associated with an erythematous rash with no other organ involvement,, or rarely as generalized or regional lymphadenopathy with or without associated regional skin rash and no other evidence of disease. Herpes simplex virus (HSV) is a well-known cause of gingivostomatitis, herpes labialis, genital ulcers, and encephalitis.

Ankylosing spondylitis and swollen supraclavicular lymph node