PMC3687590_01
Ultrasound demonstrates multiple retroperitoneal lymph node enlargements.
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Ultrasonography revealed multiple retroperitoneal lymph node enlargements (Figure 1).
Thoracic and abdominal CT shows multiple lymph node enlargements in the regions of the bilateral neck and hilum, as well as the mediastinum and retroperitoneal areas.
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An enhanced 64-slice thoracic and abdominal computerized tomography (CT) scan was obtained, which revealed multiple lymph node enlargements in the bilateral neck, lung hilum, mediastinum, and retroperitoneal area (Figure 2), and some of the lymph nodes had fused into a mass and appeared as having a moderately homogeneous enhancement.
Thoracic CT reveals reticulonodular shadows in the lung window (a); after five weeks of treatment, thoracic CT showed that the lesions of the lung were reduced (b).
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At the same time, the thoracic CT scan also revealed reticulonodular shadows in the lung (Figure 3(a)). After this patient was treated with intravenous amphotericin B (0.7 mg/kg/day) and oral flucytosine (100 mg/kg/day) for five weeks, the lung lesions and lymph nodes were markedly diminished in size (Figures 3(b) and 6).
Lymphocyte subset detection by flow cytometry, which showed that the percentages of CD3, CD3/CD8+, CD3/CD4+, CD19+, and NK were 54%, 9%, 42%, 42%, and 2%, respectively.
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Bone marrow aspiration showed elevated eosinophil granulocytes (10.5%), and peripheral blood lymphocyte subset detection by flow cytometry showed that the percentages of CD3, CD3/CD8+, CD3/CD4+, CD19+, and NK were 54%, 9%, 42%, 42%, and 2%, respectively (Figure 4).
The cervical lymph node excisional biopsy revealed a lymphohistiocytic background with several blue, spherical structures that were surrounded by clear halos, which are indicative of Cryptococcus.
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Finally, a cervical lymph node excisional biopsy was performed, revealing a lymphohistiocytic background with several blue, spherical structures surrounded by clear halos, suggestive of Cryptococcus (Figure 5).