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Seven Lessons

James F. Murphy, MD; Herbert L. Fred, MD

JAMA. 1976;235(7):742-743.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Things are seldom what they seem, Skim milk masquerades as cream.

—W S GILBERT,

H.M.S. Pinafore

PAINFUL inguinal lymph nodes and fever heralded disease in two young men. In both cases, infection paraded as the offender. The real culprit, however, was lymphoma. Lessons learned from these cases prompted this report.

Report of Cases

Case 1.—

A 30-year-old bookkeeper entered the hospital suffering from painful right inguinal masses and fever of three days' duration. Detailed inquiry supplied no clues. His only abnormalities were a rectal temperature of 39.4 C (103 F) and large, hard, fixed, extremely tender lymph nodes in the right groin. The nodes appeared above and below the inguinal ligament forming the "groove" sign (Fig 1), a characteristic of lymphogranuloma venereum.¹

Infectious lymphadenitis seemed evident. Lymphogranuloma venereum topped the list of possibilities, but a multitude of infectious maladies generated attention. The possibility of neoplasm got little consideration.

Total . . . [Full Text PDF of this Article]

Author Affiliations
From St Joseph Hospital, Houston (Drs Murphy and Fred) and the Department of Internal Medicine, University of Texas Medical School, Houston (Dr Fred).

Footnotes
Reprint requests to St Joseph Hospital, 1919 LaBranch, Houston, TX 77002 (Dr Fred).

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