The presence of these abnormal lymph nodes in an HIV-infected patient suggests two major disease categories: infection and neoplasm.1 Lymphadenopathy could be associated with any localized infectious process with lymphatic drainage to the left groin, including infections of the left leg and the perineum. The necrosis in the affected nodes brings mycobacterial infection to the top of the list of possibilities. However, other infectious processes, including cat scratch disease, are also associated with enlarged, necrotic lymph nodes.2 The affected nodes could also represent metastatic disease from a malignant tumor in the left leg or perineum; the appearance of the nodes does not suggest a specific cancer. However, the apparent necrosis lowers the likelihood of non-Hodgkin’s lymphoma, because necrosis would be atypical in untreated disease.3 Recurrence of Kaposi’s sarcoma is also unlikely, because lymph nodes that are affected by that process are typically hyperdense.1 Dr. Gandhi: This patient had lymphadenopathy in the inguinal and iliac regions that may have been caused by reactive changes, cancer, or infection, including an infection of the leg or lower abdominal wall, an STI, or an infection that spread hematogenously.4
Posted on: Wed, 14 Jan 2015 10:39:50 +0000
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