Generalized Lymphadenopathy Secondary to an Invasive Fungal Infection in an Apparently Healthy Patient

A 47-year-old woman with a history of anemia and deep vein thrombosis presented to the hospital with worsening leg edema despite treatment with warfarin. Initial laboratory results revealed leukopenia, anemia and abnormal liver enzymes. Computed tomography and positron emission tomography scans showed generalized lymphadenopathy. Cultures were negative, and lymph node and bone marrow biopsies were inconclusive. Because her clinical presentation suggested malignancy, 2 distinct regimens of empiric chemotherapy were given. She was also treated with antibiotics and antifungal drugs. After 1 month of hospitalization, the patient died. Her autopsy revealed an invasive fungal infection consistent with aspergillosis but no malignancy. Histologic studies of the lymph nodes revealed reactive inflammation without fungi. Generalized lymphadenopathy is an unusual presentation of aspergillosis, and only a few cases have been reported in patients without predisposing risk factors. These cases had granulomatous inflammation. This case demonstrates that invasive aspergillosis should be considered in patients with diffuse lymphadenopathy.