A 33-year-old African American woman was seen for a 3-day history of low-grade fever, myalgia, arthralgia, and left-sided neck swelling. She also had a history of systemic lupus erythematosus (SLE), Berger disease, and hypertension. She had no family history of malignancy or autoimmune diseases. Physical examination revealed tender bilateral cervical lymphadenopathy in both the anterior and the posterior compartments of the neck. Laboratory workup showed an elevated erythrocyte sedimentation rate (118 mm/h); anemia, with a hemoglobin level of 9.8 1 g/dL (to convert to grams per liter, multiply by 10.0); and leukopenia, with a white blood cell count of 4200/μL (to convert to ×109/L, multiply by 0.001). The platelet count and the liver enyme and lactate dehydrogenase levels were within the normal range.