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PET-CT images on admission. PET-CT on admission shows (a) multiple enlargement of subphrenic lymph nodes and (b) SUVmax 11.1 in the right inguinal lymph node.
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PET-CT demonstrated multiple enlargements of subphrenic lymph nodes (SUVmax 11.1 in the right inguinal lymph node) (Figure 1a-b).
Pathological findings of the inguinal lymph node biopsy. (a) Ziehl-Neelsen staining of the right inguinal lymph node biopsy specimen shows acid-fast bacilli in granuloma (dashed-line circle). (b) HE staining shows atypical large lymphoma cells with T cells in the background. (c) In-situ hybridization for Epstein-Barr virus-encoded small RNA (EBER-ISH) is positive. Immunohistochemical staining shows (d) EBNA-2 partially positive, and (e) PD-L1 positive (x400 (b, e), x200 (c, d) at original magnification).
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EBER-ISH was positive, and LMP-1 and EBNA-2 were also partially positive, which suggested EBV infection with latency type III (Figure 2a-e). However, Ziehl-Neelsen staining of the biopsy specimen showed acid-fast bacilli in granulomas (Figure 2a).