Angioimmunoblastic T-cell lymphoma Masquerading as Infectious Mononucleosis - a case report

Abstract

A 71 year-old patient presented with low-grade fever, sore throat, tonsils swelling with exudates, a pruritic rash and splenomegaly. Autoimmune hemolytic anemia (AIHA) was demonstrated, together with an acute Epstein-Barr virus serological profile, and evidence of acute cytomegalovirus infection. A monoclonal IgG lambda peak was found by immuno-fixation. The AIHA responded fully to Prednisone 60mg/day and a short course of Solumedrol, but the severe anemia relapsed and by the third admission to the Internal Medicine Ward, lymphadenopathy had developed, and an inguinal lymph node biopsy was performed. The lymph node largest diameter was 3.5 cm. On histology, sinuses were patent, a vague nodularity without germinal centers was evident, composed mainly of small regular B cells, while small to medium-sized T lymphocytes were predominant in the interfollicular areas. Large B-cells, mostly CD30+ immunoblasts, were scattered and EBER +++ was found mainly in and around the nodules. No evidence of necrosis was noted. We hereby discuss the differential diagnosis between infectious mononucleosis in the elderly, angioimmunoblastic T-cell lymphoma and follicular peripheral T-cell lymphoma a propos our patient.