An unusual case of disseminated lymphadenopathy.

A 54-year-old Caucasian female was admitted for fevers, night sweats, decreased appetite, weight loss of 20 pounds in 1 month, diffuse rash, and purpuric lesions on her lower extremities. Physical examination revealed a diffuse maculopapular rash on the anterior chest and trunk and a palpable, 1-cm, inguinal lymph node. Initial laboratory studies revealed hemoglobin of 9.1 g/dL, hematocrit of 28.4%, white blood count of 10.6 × 103/μL, platelet count of 486,000/μL, C-reactive protein of 224.3 mg/L, erythrocyte sedimentation rate of 88 mm/hr, and serum lactate dehydrogenase of 257 U/L. Normal results were found in analysis of rapid plasma regain, blood cultures, rheumatoid factor, antinuclear antibody, direct Coombs test, cytoplasmic antineutrophil cytoplasmic antigen (ANCA), perinuclear staining ANCA, atypical perinuclear ANCA, cancer antigen 125, and carbohydrate antigen 19-9. HIV testing was negative. Computed tomography (CT) with contrast of the chest, abdomen, and pelvis revealed extensive mediastinal, retroperitoneal, periaortic, pelvic, and inguinal lymphadenopathy. An inguinal lymph node biopsy and bone marrow biopsy showed no evidence of lymphoma. The right inguinal lymph node biopsy revealed granulomatous inflammation and caseating necrosis. The