# Case Report

## Patient Presentation

21-years old male with 1 week of low-grade fever (up to 37,6°C), malaise, mild sore throat, dry cough, painful lymph nodes of neck and bilateral hip pain. During last two weeks he lost 6 kg. He didn't have night sweats. Last few days have "hissing in the lungs".

## Physical Examination

Physical exam showed one enlarged lymph node in each axilla (~2 cm, movable, painless), slight pharyngeal hyperemia, more highly pitched bronchial sound in right middle lung field paravertebrally, slight tenderness in right paraumbilical area of abdomen. The rest of exam was normal.

## Laboratory Findings

Laboratory analyses showed only elevated CK (384) and slightly lower AP (42). CBC and rest of the biochemistry was normal.

Ultrasound of axillae showed one enlarged (~2 cm) reactive lymph node in each axilla. The lymph nodes in neck area were normal.

Abdominal X-ray and ultrasound of abdomen were normal.

Chest X-ray showed left (para-)hilar mass 40 x 50 mm in size, for which the radiologist noted that could be an enlarged lymph node (but he wasn't sure).

## Differential Diagnosis

I have ideas that this could be lymphoma, sarcoidosis, atypical Löfgren syndrome (no erythema nodosum), other neoplasms. TB for me is less likely because of quick course.

## Discussion

What is your opinion?

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### Other Cases for Reference

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