PMC9795510_01
This is a PET-CT, transverse view, of the pelvis at the level of the pubic symphysis exhibiting FDG-Avidity of the left inguinal lymph node, from which the consequential diagnostic biopsy was taken.
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Protein Electrophoresis (SPEP and UPEP) with Immunofixation identified IgG kappa and weak IgA lambda bands, consistent with underlying CLL/SLL. Positron-emission tomography-computed tomography (PET-CT) scan exhibited the previously identified diffuse lymphadenopathy with high levels of fludeoxyglucose (FDG) avidity, consistent with metabolically active disease and Richter Transformation (Fig. 1, Fig. 2).
Lymph node biopsy tissue showing diffuse small lymphocytes with large necrotic areas (A). Positivity for CD5 (B) and CD20 (C) and HSV-1 and HSV-2 (D) on immunohistochemical studies.
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Subsequent stains of the new biopsied node exhibited HSV-1 and HSV-2 positivity, confirming the diagnosis of necrotic HSV lymphadenitis (Fig. 3).