swollen lymph nodes - size of marbles

Question

Hi there doctor,

I recently started Atripla, and got undetectable in just 3 months - hurrah for that. Two weeks ago, I developed painfull swollen lymph nodes in my groin, both sides. They popped up in a couple of days... Now, i did have unsafe sex about a week prior to that. I have a problem with recurring anal warts too, which are getting treated late january. My HIV physician - whom i visited last week - is doing some bloodworks to see if a bug is causing the lymphadenopathy. An ultrasound was already made and shows enlarged lymph nodes on both sides (duh... they're the size of big marbles, the echo just confirms what can be seen with the naked eye). I'm scheduled for a tuberculosis test, some blood works are underway, and i've got an appointment for the removal of a lymph node later next week for an anatome-pathological assessment. Any other things I should be worrying about? Given the speed and location (multiple lymphnodes, both sides), should i worry about hodgkin/non-hodgkin or castleman's? i did some work on NHL in the past (am a lab technician) so know a bit about these things.

thanks for a quick reply - i'm getting a bit nerveous...

Answer

Glad to hear that your doc is moving fast to sort things out.

If your CD4 count had been low prior to staring Atripla, this could be an immune reconstitution to something that grows in lymph nodes like TB, or histoplasmosis (or other fungal illness). Usually this would be accompanied by other symptoms such as fever, sweats, etc.

It is reassuring that they are equal on both sides, sometimes lymphomas are more on one side tha the other (asymmetrical).

Rceent unsafe sex increasese the likelihood of herpes (which can easily cause bilateral tender lymph nodes) or chancroid.

Lymph nodes in the groin are usually more common than in other areas, have you had a scan to see if you have these nodes internally? Can you feel them around your neck or under the arms? If so it makes a sexually transmitted disease less likley.

Castleman's can cause swollen glands, but usually the person will also have fever, anemia and feel quite unwell.

I wish you the best, the biopsy of the node should be very helpful. Whatever is going on keeping your virus undetectable is the best way to handle it at this point. Best to you, Joe