case_images: PMC9908427_01
case_images: CXR demonstrating clear lungs and pleural spaces. No radiographic evidence of acute pulmonary disease.
case_images: cureus-0015-00000033562-i01.jpg
case_images: PMC9908427_01_cureus-0015-00000033562-i01.jpg
case_images: FIG1
case_images: C-telopeptide (534 pg/mL; reference range: 25-573 pg/mL for premenopausal) and a complete blood count with peripheral blood smear revealing microcytic hypochromic anemia, mild lymphopenia, and mild monocytosis with adequate reticulocytosis. Serum-free light chains showed a high free kappa (3.58 mg/dL; reference range: 0.33-1.94 mg/dL), normal free lambda (2.59 mg/dL; reference range: 0.57 to 2.63 mg/dL), and a normal free kappa/lambda ratio (1.38; reference range: 0.26-1.65). Ultrasound of the abdomen showed a 7mm non-obstructing calculus in the mid-right kidney. Chest X-ray revealed no hilar lymphadenopathy or acute process (Figure 1).
case_images: CT of the abdomen demonstrating splenomegaly.
case_images: cureus-0015-00000033562-i02.jpg
case_images: PMC9908427_01_cureus-0015-00000033562-i02.jpg
case_images: FIG2
case_images: A CT of the chest, abdomen, and pelvis with contrast revealed mild nonspecific splenomegaly with nonspecific upper mediastinal, left hilar, and left supraclavicular adenopathy up to 10 mm and mildly enlarged upper abdominal and retroperitoneal lymph nodes up to 10-17 mm (Figures 2-4).
case_images: CT of the chest showing a mildly enlarged superior mediastinal lymph node between the left subclavian and left common carotid artery.
case_images: cureus-0015-00000033562-i03.jpg
case_images: PMC9908427_01_cureus-0015-00000033562-i03.jpg
case_images: FIG3
case_images: A CT of the chest, abdomen, and pelvis with contrast revealed mild nonspecific splenomegaly with nonspecific upper mediastinal, left hilar, and left supraclavicular adenopathy up to 10 mm and mildly enlarged upper abdominal and retroperitoneal lymph nodes up to 10-17 mm (Figures 2-4).
case_images: CT of the chest demonstrating left axillary lymphadenopathy.
case_images: cureus-0015-00000033562-i04.jpg
case_images: PMC9908427_01_cureus-0015-00000033562-i04.jpg
case_images: FIG4
case_images: A CT of the chest, abdomen, and pelvis with contrast revealed mild nonspecific splenomegaly with nonspecific upper mediastinal, left hilar, and left supraclavicular adenopathy up to 10 mm and mildly enlarged upper abdominal and retroperitoneal lymph nodes up to 10-17 mm (Figures 2-4).
case_images: Bone marrow biopsy demonstrating small non-caseating granulomas.
case_images: cureus-0015-00000033562-i05.jpg
case_images: PMC9908427_01_cureus-0015-00000033562-i05.jpg
case_images: FIG5
case_images: Because of the absence of palpable lymph nodes on physical exam and no probable targets for excisional biopsy seen on imaging, a bone marrow biopsy was performed and showed a normocellular bone marrow with trilineage hematopoiesis and small noncaseating granulomas (Figure 5).
case_images: Skin biopsy demonstrating non-caseating granulomas.
case_images: cureus-0015-00000033562-i06.jpg
case_images: PMC9908427_01_cureus-0015-00000033562-i06.jpg
case_images: FIG6
case_images: It was negative for fungal elements or bacterial colonies (Figure 6).