PMC6739527_01
Radiology (computed tomography coronal images of the chest, abdomen and pelvis, a-c). Multiple conglomerate nodal masses are seen along the mesenteric, aorta, iliac and para-aortic nodal chains. There are also enlarged nodes in the porta hepatis. Several of the upper abdominal mesenteric nodes demonstrate low density, compatible with central necrosis. Diffuse hepatomegaly with no discrete lesion is seen.
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Abdominal computed tomography (CT) scan and ultrasound revealed massively enlarged intra-abdominal lymph nodes (see Figure 1) with a moth-eaten appearance of the spleen.
Histological images of the duodenum and lymphnode. (a) Histology of the duodenal mucosa showing lamina propria expansion by histiocyte sheets (hematoxylin and eosin, 100x). (b) Duodenal villus filled with abundant organism-containing histiocytes (hematoxylin and eosin, 400x). (c) Lymph node replaced by sheets of histiocytes with scattered intervening inflammatory cells (hematoxylin and eosin, 100x). (d) Lymph node histiocytes revealing finely granular to foamy cytoplasm, engorged with bacilli (hematoxylin and eosin, 400x). (e) Ziehl-Neelsen stain demonstrating large numbers of acid-fast bacilli in duodenal histiocytes (400x). (f) Periodic acid-Schiff stain showing granular positivity in the histiocyte intracytoplasmic organisms (400x).
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Histological images of the duodenum and a lymph node are shown in Figure 2.