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Rare disease
CASE REPORT
Chronic lymphocytic leukaemia with necrotic herpetic adenitis: an elusive clinical condition
  1. Roma Srivastava1,
  2. Doreen Griswold2,
  3. Muhammad Omer Jamil1
  1. 1 Department of Hematology/Medical Oncology, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
  2. 2 Department of Pathology, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
  1. Correspondence to Dr Roma Srivastava, romaonco{at}gmail.com

Summary

Herpes simplex virus (HSV) adenitis is a rare but important cause of morbidity in immunocompromised patients. Chronic lymphocytic leukaemia (CLL)/Small lymphocytic lymphoma (SLL) is an indolent disease which impairs the cellular and humoral immunity, predisposing patients to a myriad of infections. Clinically, herpetic adenitis can mimic large cell (Richter’s) transformation in patients with CLL. To date, less than 30 cases of HSV adenitis have been reported in the literature. We report a case of a patient with CLL with no prior history of HSV infection, who presented with rapidly enlarging lymph nodes after initial response to idelalisib raising the suspicion of Richter’s transformation. However, excisional biopsy of a lymph node revealed HSV adenitis along with CLL, which was confirmed by immunohistochemical staining.

  • haematology (drugs and medicines)
  • infections
  • malignant and benign haematology
  • cancer intervention

https://doi.org/10.1136/bcr-2017-222091

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    Footnotes

    • Contributors RS: Participated in patient care, prepared the initial draft of the case report, revised the manuscript critically, approved the version to be published and agreed to be accountable for all aspects of the work. DG: Examined the slides and made the pathological diagnosis, provided the key images, revised the manuscript critically, approved the version to be published and agreed to be accountable for all aspects of the work. MOJ: Primary oncologist, participated in patient care, revised and amended the manuscript critically, approved the version to be published and agreed to be accountable for all aspects of the work.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.