Photo Quiz: A Man with Lymphadenopathy and Lethargy

A 45-year-old Chinese male presented with lymphadenopathy, irregular fever, and lethargy. The patient had traveled to the Gabonese Republic in West Africa as a member of a labor export service and had stayed there for 6 months every year for the past 4 years. On examination, multiple papules were observed on the skin of the front chest (Fig. 1A). Lymphadenopathy was observed in the right neck and the bilateral axilla. Mild splenomegaly was present. The serum immunoglobulin IgM level was increased to 27.5 g/liter. An axillary node biopsy demonstrated reactive follicular hyperplasia, and no malignancy was noted (Fig. 1B). Numerous structures were found in the peripheral blood smear (Fig. 1C).

FIG 1.

(A) Multiple papules observed on the front chest. (B) An axillary node biopsy demonstrated reactive follicular hyperplasia with CD38 staining (magnification, ×200). (C) Structure found in the blood film.

(For answer and discussion, see page 2843 in this issue [doi:10.1128/JCM.03295-14].)