FP-5. Necrotizing immunoblastic and lymphoid hyperplasia mimicking nasopharyngeal lymphoma.Infectious mononucleosis (IM) usually has a benign course, but a great variety of complications have been reported. We describe a patient with IM with severe upper airway obstruction. A previously healthy 21-year-old male was admitted with progressive dyspnea. On arrival to the emergency department he was noted to be tachypneic and tachycardic. In mild distress, breathing through his mouth with a "hot potato voice." There was no stridor Stridor Definition Stridor is a term used to describe noisy breathing in general, and to refer specifically to a high-pitched crowing sound associated with croup, respiratory infection, and airway obstruction. and lungs were clear to auscultation auscultation Procedure for detecting certain defects or conditions by listening for normal and abnormal heart, breath, bowel, fetal, and other sounds in the body. The invention of the stethoscope in 1819 improved and expanded this practice, still very useful despite the . His physical exam was otherwise unremarkable except for splenomegaly splenomegaly /sple·no·meg·a·ly/ (-meg´ah-le) enlargement of the spleen. congestive splenomegaly Banti's disease; splenomegaly secondary to portal hypertension. . Lateral neck x-ray demonstrated "obliteration of the nasopharynx and a possible epiglottis epiglottis (ĕp'əglŏt`ĭs): see larynx. ." Bedside rhinoscopy rhinoscopy /rhi·nos·co·py/ (ri-nos´kah-pe) examination of the nose with a speculum, either through the anterior nares (anterior r.) or the nasopharynx (posterior r.) . rhi·nos·co·py n. revealed complete obliteration of the posterior nasopharynx by a soft tissue mass. Pertinent lab findings included a AST 113, ALT 295, ALP 249, WBC of 9.100 with 45% atypical lymphocytes. Maxillofacial tomography revealed a 7 X 3-cm obstructive nasopharyngeal mass extending from the skull base to the oropharynx "highly suspicious for lymphoma." Suspected lymphomatous tonsillar tonsillar /ton·sil·lar/ (ton´si-lar) of or pertaining to a tonsil. ton·sil·lar or ton·sil·lar·y adj. Of or relating to a tonsil, especially the palatine tonsil. enlargement with a 2.5-cm jugulodigastric node. Initial biopsy suggested nasopharyngeal lymphoma but was inconclusive. A subsequent biopsy yielded strongly positive staining for EBV latent membrane protein with histologic diagnosis of necrotizing necrotizing /nec·ro·tiz·ing/ (nek´ro-tiz?ing) causing necrosis. Necrotizing Causing the death of a specific area of tissue. Human bites frequently cause necrotizing infections. immunoblastic and lymphoid hyperplasia, consistent with an acute response to EBV infection. Over the next 3 weeks the patient had complete resolution of the nasopharyngeal obstruction. There are several case reports of nasopharyngeal obstruction due to EBV associated to hyperplasia of the Waldeyer's ring. Previous case reports suggest that this affects a younger population with an average of 11.1 years. In our 21-year-old patient the diagnosis was confusing due to the signs, imaging and pathologic suspicion of nasopharyngeal lymphoma. Although unproven the general thought is that EBV has a role in nasopharyngeal carcinomas. As our case illustrates, upper airway obstruction is seen in IM, which sometimes may mimics nasopharyngeal lymphoma. A. Marte, MD, C.S. Sonnier, MD, and J. Lantz, MD. University of Virginia Roanoke-Salem Program, Roanoke, VA. |
|
||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion