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Ameneh Khatami and Emilie Huguon
A previously well adolescent from the tropical South Pacific island of Futuna was transferred due to a 3-month to 4-month history of intermittent fevers, anorexia, weight loss, lethargy and haemoptysis. A Mantoux test was negative. CT scan demonstrated a large mediastinal mass and lymphadenopathy with broncho-vascular compression, and bilateral pleural and pericardial effusions, (figure 1A). At admission, he was persistently febrile with non-tender cervical lymphadenopathy and hepatomegaly, and had moderate respiratory distress. The presumptive diagnosis was lymphoma.
Initial blood tests demonstrated haemoglobin 92 g/L; white cell count 16×109/L (neutrophils 11×109/L, lymphocytes 1.3×109/L, eosinophils 1.2×109/L); erythrocyte …