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March 2, 1979

Immunoblastic LymphadenopathyPatient With Prolonged Fever of Unknown Origin

Author Affiliations

From the Department of Medicine, University of Manitoba (Drs MacDougall and Weinerman), and Sections of Internal Medicine (Dr MacDougall) and Oncology (Dr Weinerman), St Boniface General Hospital, Winnipeg, Manitoba.

JAMA. 1979;241(9):921-922. doi:10.1001/jama.1979.03290350041021

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