WHAT IS YOUR DIAGNOSIS? A 25-YEAR-OLD WOMAN WITH COUGH, CONSTITUTIONAL SYMPTOMS AND LYMPHADENOPATHY

WHAT IS YOUR DIAGNOSIS? A 25-year-old woman was admitted with malaise, mild fever, night sweats and intermittent non-purulent cough since six months ago. Her symptoms gradually progressed during the previous weeks and recently she experienced nausea and mild dyspnea on exertion. On physical examination, she was ill and pale with stable vital signs. There was a mobile, elastic and non-tender lymph node in right neck base near a previous lymphadenectomy scar. Cardiopulmonary examination revealed a systolic III/VI murmur. Mild splenomegaly, clubbing, multiple Beau’s lines on her fingernails and mildly destroyed left fungal toenails were also found. She was a rural married housewife with one healthy child. Her husband had no significant medical history. She had a few thallasemic relatives in her both parental families. In her past medical history she complained of painful oral aphthous lesions occurring 3-4 times a year and denied morning stiffness in her joints, photosensivity or other rheumatologic symptoms. She had undergone cervical lymphadenectomy and thoracotomy 2 months ago. Histopathological examination revealed a reactive lymphadenitis and hyperplasia, plasmacytosis and vascularization in cervical and mediastinal lymph nodes, respectively. Laboratory test results are demonstrated in Table 1.