A 29-year-old female with no medical history presented to the emergency department with 6 weeks of a chronic cough and fever. Chest X-ray showed mediastinal widening concerning for lymphadenopathy. A follow-up computed tomography (CT) scan showed multiple masses in the mediastinum, lung, liver, and retroperitoneum (Image 1 & 2). They were measured up to 3 cm in size, and a large infiltrative mass in the lower pole of the left kidney invading the renal pelvis measured 5.7 × 5.6 × 6 cm (Image 3). Admission laboratory tests revealed normocytic anemia, mildly elevated white cell count, and an elevated platelet count (Hg of 8.9 g/dL, MCV 87 fL, WBC 12,000/µL, platelets 573,000/µL).
Chemistry labs revealed elevated LDH (584 U/L) with normal kidney and liver function. HIV workup was negative. The patient underwent a transbronchial endoscopic ultrasound with biopsy of station 4R. She was…
