A Man With Fever, Gingival Plaque, and Diffuse Lymphadenopathy

A 31-year-old man without any known underlying disease presented with a 5-day history of intermittent fever and diffuse abdominal pain. He complained of a gingival lesion and painless neck swelling of 1 month’s duration, and fatigue and poor appetite of 3 months’ duration. A 10 kilogram weight loss was also noted. He came from Vietnam and worked as a construction worker in Taiwan for 1 year. There was no history of exposure to pets or use of injected drugs. Physical examination revealed oral candidiasis, granulomatous gingiva (Figure 1), multiple palpable left supraclavicular and cervical lymph nodes (the largest up to 3.0 3 2.5 cm, and hepatosplenomegaly. Laboratory investigation revealed a white blood cell count of 5.8 3 10 cell/L with 91% neutrophils and 4% lymphocytes, a hemoglobin level of 11.2 g/dL, a platelet count of 180 3 10 cells/L, a C-reactive protein level 49.2 mg/L, Figure 1. Erythematous gingival surface.