A 63-year-old woman with a history of large B-cell non-Hodgkin lymphoma in the right tonsil three years ago.
Treatment consisted of eight doses of rituximab, cyclophosphamide, hydroxyrubicin, vincristine and prednisolone (R-CHOP protocol) every 21 days for five months, with total remission.
In a follow-up visit, a slight increase in the enzyme lactate dehydrogenase (LDH) was observed 535 IU/L and 567 IU/L, repeated ten days later (reference value: 480 IU/L).
Hematological count, renal and hepatic function were normal.
No significant changes were observed in computed tomography (CT) of the oropharynx, neck, thorax, abdomen and pelvis.
The patient was asymptomatic and had a normal physical examination, with a healthy oropharynx, without lymphadenopathy or hepatosplenic enlargement.
The patient was afflicted with no weight loss and no night sweats.
The patient informed about the extraction of a right molar two months before.
Due to the possibility of a relapse of lymphoma, a positron emission tomography-computed tomography (CT-EPT) with fusion images was performed using a radiolabelled 18F-2-floor-2-deoxy-glucose thick oropharyngeal uptake.
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The patient underwent surgical removal of the lesion.
Histopathological examination was negative for a malignant process.
The palatine tonsil revealed a nonspecific reactive follicular lymphoid hyperplasia.
Hematoxylin and eosin staining (40x) showed a bacterial group in a philate form compatible with acticidosis (sulphur granules).
Antimicrobial treatment with amoxicillin/clavulanic acid 500/125 mg for two months was indicated.
During follow-up, there were no changes in the clinical examination, with normal LDH values.
