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Generalized peripheral lymphadenopathy in a patient treated for chronic HCV infection

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 469–474 (2008)Cite this article

Abstract

Background A 62-year-old white woman was admitted to hospital with a 2-month history of progressive, painless, left supraclavicular and axillary lymph node enlargement. The patient's history was significant for chronic HCV infection, for which she had just completed a 48-week course of treatment with pegylated interferon α (180 µg once weekly) plus ribavirin (1,000 mg daily). She attained an end-of-treatment response and subsequent qualitative measurement of HCV RNA confirmed a sustained virological response. The onset of progressive painless lymph node enlargement had been noted by the patient during the last 2 weeks of her treatment for HCV.

Investigations Physical examination, otorhinolaryngological examination, laboratory investigations (including complete blood counts, liver function tests and serological tests), mammography, thyroid and abdominal ultrasound, CT scans, abdominal MRI, upper gastrointestinal endoscopy, colonoscopy, supraclavicular lymph node biopsy, 67Ga scintigraphy and bronchoalveolar lavage.

Diagnosis Granulomatous lymphadenitis of uncertain etiology with sarcoid-type and tuberculoid-type granulomas.

Management Standard antituberculosis treatment with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months, followed by isoniazid and rifampicin for 7 months.

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Figure 1: A thoracic CT scan of the case patient.
Figure 2: Histological features of a lymph node biopsy from the case patient.
Figure 3: Images obtained by a 67Ga scan of the case patient.

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Acknowledgements

We would like to thank Professor R Marinho and Dr C Baldaia for their helpful suggestions during the drafting of the article and also for their words of encouragement.

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Authors and Affiliations

  1. and E Monteiro is the Director of the Gastroenterology and Hepatology Division at the Hospital Santa Maria, C Noronha Ferreira is a Gastroenterology Fellow, ER Barjas is a Gastroenterologist, LA Correia is a Consultant Gastroenterologist, FL Serejo is a Consultant Hepatologist, Lisbon, Portugal.,

    Carlos Noronha Ferreira, Elidio R Barjas, Luis A Correia, Fatima L Serejo & Estela Monteiro

  2. E Monteiro is also Head of the team of hepatologists at the Liver Transplant Unit at Hospital Curry Cabral, Lisbon, Portugal.,

    Estela Monteiro

  3. L Tavares is a Specialist in Infectious Diseases at Hospital Nossa Senhora do Rosário, Barreiro, Portugal.,

    Luis Tavares

  4. C Ferreira is a Pathologist at the Department of Pathology, Hospital Santa Maria, Lisbon, Portugal.,

    Cristina Ferreira

  5. and former Director of the Gastroenterology and Hepatology Division at Hospital Santa Maria, M Carneiro de Moura is a Consultant Hepatologist currently at the Liver Unit, Institute of Molecular Medicine, Medical School of Lisbon, Lisbon, Portugal.,

    Miguel Carneiro de Moura

Authors
  1. Carlos Noronha Ferreira
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Corresponding author

Correspondence to Carlos Noronha Ferreira.

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The authors declare no competing financial interests.

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Ferreira, C., Barjas, E., Correia, L. et al. Generalized peripheral lymphadenopathy in a patient treated for chronic HCV infection. Nat Rev Gastroenterol Hepatol 5, 469–474 (2008). https://doi.org/10.1038/ncpgasthep1176

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