CASE FOR DIAGNOSIS Hoarseness, cough and cervical lymphadenopathy

CASE HISTORY A 43-yr-old native Brazilian female complained of a sore throat, recent onset of hoarseness, progressive pain and bilateral swelling of the neck during the past 6 months, when she presented at the University Hospital of Zurich (Zurich, Switzerland) for the first time. The patient had moved to Switzerland 5 yrs before, had been a heavy smoker for the past 20 yrs and coughed chronically. She reported a short episode of minor haemoptysis 2 yrs previously that had ceased spontaneously. The patient suffered no fever or night sweats, but had lost 2 kg of weight during the past 2 months, despite a normal appetite. Five months previously, she had spent 3 months in a town south of the capital Brasilia, where she was treated with sulphamethoxazole and trimethoprim for pneumonia. After a transient recovery, the cough, sore throat and cervical swelling reappeared.