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May 30, 1977

Immunoblastic Lymphadenopathy Presenting as Pulmonary Interstitial Fibrosis

JAMA. 1977;237(22):2411-2412. doi:10.1001/jama.1977.03270490051028

IMMUNOBLASTIC lymphadenopathy commonly presents with fever, chills, night sweats, and malaise.1 The usual physical findings are lymphadenopathy, hepatosplenomegaly, and a maculopapular erythematous rash. Laboratory features include positive Coombs test, mild to moderate hemolytic anemia, mild leukocytosis, and polyclonal hypergammaglobulinemia. Frequently there is a history of previous drug exposure. In addition to the usual presenting features, our patient had bilateral pleural effusions and interstitial fibrosis with nodularity.

Report of a Case  A 78-year-old woman was admitted to a referral hospital with a four-month history of fever, chills, night sweats, and a nonproductive cough. Chest x-ray films showed a diffuse infiltrate and bilateral effusions. Treatment with ampicillin trihydrate resulted in moderate improvement. Prednisone treatment was added because of the patient's long history of arthritis. One month later, exertional dyspnea, two-pillow orthopnea, paroxysmal nocturnal dyspnea, and nocturia developed. Bilateral effusions were again present, and a pleural fluid complement was low. A presumptive