Case 32-1983

Presentation of CaseA 31-year-old man was admitted to the hospital because of persistent fever and cranial-nerve defects.He was well until eight months earlier, when fatigue, anorexia, and intermittent fever developed, followed by the onset of a cough; during the next few months he lost 16 kg in weight. Six months before admission he entered another hospital, where physical examination showed cervical lymphadenopathy. An x-ray film of the chest (Fig. 1) revealed a left pleural effusion and a widened mediastinum. Microscopical examination of a biopsy specimen of a cervical lymph node and a specimen of bone marrow disclosed caseating . . .