case_images: PMC11785414_01
case_images: CT chest demonstrating left axillary lymphadenopathy. The measurement bar (end of the yellow arrow) indicates that the largest diameter of the enlarged lymph node was 12.7 mm.. CT, computed tomography
case_images: cureus-0017-00000076751-i01.jpg
case_images: PMC11785414_01_cureus-0017-00000076751-i01.jpg
case_images: FIG1
case_images: He reported rib pain and - on a CT scan ordered to rule out rib fracture - was incidentally found to have bulky left axillary lymphadenopathy (Figure 1).
case_images: Histopathology slides from the left axillary lymph node biopsy. Figure 2A presents an H&E stain of the lymph node, showing areas of normal tissue and areas of disease, including Reed-Sternberg cells, which are seen more clearly in the zoomed H&E stain, Figure 2B. Figure 2C is a CD30 stain, demonstrating the presence of Hodgkin cells. Figure 2D represents Epstein-Barr virus in ISH, showing the presence of the virus in large Hodgkin-like cells.. H&E, hematoxylin and eosin; CD, cluster of differentiation; ISH, in situ hybridization
case_images: cureus-0017-00000076751-i02.jpg
case_images: PMC11785414_01_cureus-0017-00000076751-i02.jpg
case_images: FIG2
case_images: Initial pathology results were inconclusive, and the sample was sent for expert opinion, which - based on his clinical history and current medications - resulted in the diagnosis of iatrogenic EBV-positive B-cell lymphoproliferative disorder with Hodgkin-like features (Figures 2A-2D).
case_images: Initial PET imaging showing diffuse lymphadenopathy. Figure 3A shows bulky left axillary lymph nodes, the largest measuring up to 3 x 1.9 cm. Figure 3B shows a mediastinal lymph node measuring 1.2 cm. Figure 3C shows an infraclavicular lymph node measuring 1.5 x 0.7 cm. Figure 3D shows a left para-aortic retroperitoneal lymph node measuring 0.5 cm. Respective lymph nodes are indicated by yellow arrows in each pane.. PET, positron emission tomography
case_images: cureus-0017-00000076751-i03.jpg
case_images: PMC11785414_01_cureus-0017-00000076751-i03.jpg
case_images: FIG3
case_images: An initial PET scan demonstrated lymphadenopathy in the left axilla, left neck, subcarina, and retroperitoneum (Figures 3A-3D).
case_images: Epstein-Barr virus levels over the course of the disease. EBV level trend (measured in copies/mL), M4 representing month four after diagnosis. The large reduction in the EBV level occurred after withdrawal of immunosuppression between months five and six.. EBV, Epstein-Barr virus; M4, month 4 after diagnosis; M15, month 15 after diagnosis (and so on)
case_images: cureus-0017-00000076751-i04.jpg
case_images: PMC11785414_01_cureus-0017-00000076751-i04.jpg
case_images: FIG4
case_images: Unfortunately, between months eight and nine after diagnosis, he developed new lymphadenopathy and up-trending EBV levels (Figure 4).
case_images: PET/CT scan at eight months after diagnosis. Representative image from a repeat PET/CT at eight months, demonstrating a mediastinal lymph node, which had grown from previous imaging to 1.22 cm. Lymphadenopathy had also progressed in the epicardium, retroperitoneal area, and right supraclavicular region (not shown).. CT, computed tomography; PET, positron emission tomography
case_images: cureus-0017-00000076751-i05.jpg
case_images: PMC11785414_01_cureus-0017-00000076751-i05.jpg
case_images: FIG5
case_images: A repeat CT/PET scan indicated progressive disease (Figure 5).
case_images: PET/CT between months 14-15 after diagnosis. Full-body image demonstrating multiple areas of high FDG uptake, consistent with widespread lymphoproliferative disease.. CT, computed tomography; PET, positron emission tomography; FDG, fluorodeoxyglucose
case_images: cureus-0017-00000076751-i06.jpg
case_images: PMC11785414_01_cureus-0017-00000076751-i06.jpg
case_images: FIG6
case_images: Repeat imaging demonstrated relapse (Figure 6).