Herpes simplex lymphadenitis in association with chronic lymphocytic leukaemia

Abstract

Herpes simplex lymphadenitis is a rare condition that is most commonly seen in immunocompromised patients. To date, less than 30 cases have been reported in the literature. It is most commonly seen in patients with haematological malignancy, especially with chronic lymphocytic leukaemia. However, it can be associated with other neoplasms such as Hodgkin lymphoma, mantle and marginal zone B-cell lymphoma, acute and chronic myeloid leukaemia. Presentation can be varied from localised lymphadenopathy, generalised lymphadenopathy with or without a rash, and disseminated HSV infection with multiple organ involvement. Histologically, it shows areas of coalescing necrosis and inflammatory cell infiltrates including histiocytes and neutrophils. Multinucleate cells with ground glass nuclei and Cowdry type A intranuclear inclusions are diagnostic; the diagnosis can be confirmed with herpes simplex virus in-situ hybridisation or immunohistochemistry. Differential diagnoses to consider include cat scratch lymphadenitis, mycobacterial tuberculosis lymphadenitis, Kikuchi-Fujimoto lymphadenitis, systemic lupus erythematosus, Hodgkin lymphoma and large cell non-Hodgkin lymphoma. Herpes simplex lymphadenitis is an important diagnosis which can mimic transformation of an underlying haematological malignancy. We present a case of a 68-year-old male with localised lymphadenopathy and history of chronic lymphocytic leukaemia.