Herpes Simplex Virus Necrotic Lymphadenitis Masquerading as Lymphoma

TL;DR

A patient with chronic lymphocytic leukemia had lymph node swelling caused by a herpes virus, not cancer.

Contribution

Highlights a rare case where herpes simplex virus mimicked lymphoma in an immunocompromised patient.

Findings

Lymph node biopsy confirmed herpes simplex virus lymphadenitis, not lymphoma progression.

Flow cytometry ruled out transformation to aggressive diffuse large B-cell lymphoma.

Emphasizes the need for broad differential diagnosis in immunocompromised patients with lymphadenopathy.

Abstract

In immunocompromised patients, the rapid development of lymphadenopathy could pose a few diagnostic challenges. This is important, especially with chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) which can manifest with the development of infections or may even progress with transformation into a more aggressive form of the disease. We report a case of a patient with CLL/SLL who presented with fever and worsening dyspnea as well as inguinal lymphadenopathy upon evaluation. The excisional biopsy of affected lymph nodes revealed herpes simplex virus lymphadenitis confirmed by immunohistochemical staining. Flow cytometry showed no progression to diffuse large B-cell lymphoma. This case highlights the importance of considering a broad spectrum of differential diagnoses when assessing lymphadenopathy in immunocompromised patients receiving active immunosuppressive therapy.

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