The patient was a 29-year-old man with a history of two admissions for febrile syndrome in the last two years.
On one occasion, in June 1999, the patient was diagnosed with infectious mononucleosis with positive serology for EBV (IgG ACV, IgM ACV and EBNA).
In the other case, in September 2000, after presenting a clinical picture of 10 days of fever with chills, asthenia and general malaise with persistence of positive serology for EBV, and there was a marked increase in the abdominal abscess.
Since then she remained asymptomatic until she was readmitted in June 2001 for a fever of one week duration, accompanied by chills, headache, odynophagia and weight loss, without other accompanying symptoms.
The physical examination revealed Ta 39 oC, affectation of the general condition, cutaneous mucosal authenticity and scleromegaly.
Laboratory tests showed normocytic anemia (Hb 11.9 g/dl, Hto 35.8% and MCV = 91.8 UI with mild thrombophilia/penia (44,000 platelets/mm3), white blood cells (7.440/mm).
The rest of the biochemical parameters, coagulation study and urinalysis were normal.
Proteinogram, immunoglobulin determination and immunological study were normal.
Several microbiological studies were carried out including serology of hepatitis virus (A, B and C), retrovirus (VIH-1 and 2), typhupho-paratyphic, brucella, mycoplasma capsula antigen, herpes
The EBV serology results were IgG anti-VCA IgG and IgG anti-EBNA positive and IgM anti-VCA negative.
The rest of microbiological studies ( sputum culture, sputum culture and urine culture), which included the positive results, were negative.
Imaging tests, particularly abdominal CT scans, revealed a focal splenic lesion (related to abscess or infarction), enlarged lymph nodes in number at the paraaortic level and adenopathies in the mesentery.
In other studies, the results (microbiological and histopathological) obtained from liver and bone marrow biopsy were negative.
Cef-abdominal abscess was initially suspected and antibiotic treatment with ceftazidime, metronidazole and vancomycin was started, with mild clinical improvement.
Subsequently, given the history and clinical picture discussed, and in order to rule out, among other diagnostic possibilities, a lymphoproliferative process, a diagnostic laparotomy under general anesthesia was performed.
In this intervention, an important focal nodule was found in the same site: thickening of the hepatic capsule of the left hepatic lobe, a small peritoneal nodule in the mesentery of the distal ileum, multiple lesions and small adenopathies.
The histological study of the lymph nodes indicated reactive lymphadenitis in the lymph nodes, granuloma calcified in peritoneal nodule and without relevant findings in the left liver lobe sample.
The cystectomy piece, weighing 442 grams and measuring 15 11 cm, presented a nodule with a subdiameter of 2 cm, homogeneous and whitish diameter.
The remaining splenic tissue was congestive without showing any pathology.
Microscopic analysis revealed a proliferation of spindle cells and myofibroblast diagnosis, with positivity in immunohistochemical studies for actin and negativity for ALK 1 and EBV inflammatory pseudotum.
Since then, the patient became asymptomatic.
