Further clinical data: A biopsy of a cervical lymph node and a thoracoscopic left pleural biopsy were performed.

Histologic Changes

Cervical lymph node: A low-power view of the cervical lymph node shows necrotic nodules surrounded by a layer of pale histiocytes. Giant cells and non-necrotizing granulomas were absent. An acid-fast stain revealed beaded bacilli consistent with mycobacteria.

Pleural biopsy: Non-necrotizing granulomas with central, epithelioid cells and surrounding lymphoid cells are present. Giant cells are absent. No acid-fast organisms were found.

Case summary Diagnosis 1

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