Intended for healthcare professionals

Endgames Case Review

Inguinal lymphadenopathy in an HIV seropositive patient

BMJ 2019; 366 doi: (Published 10 July 2019) Cite this as: BMJ 2019;366:l2284
  1. Ranjan Kumar Singh, consultant1,
  2. Dipak Kumar, senior medical officer1
  1. 1ART Center, District Hospital, Khagaria, India
  1. Correspondence to R Kumar Singh dr_ranjankumarsingh{at}

A 40 year old man with HIV presented with a four week history of a painful mass in the left inguinal region and low grade fever. He had been taking antiretroviral drugs (tenofovir, lamivudine, and efavirenz) for the past four years. He had no recent history of animal scratch. Clinical examination revealed multiple massively enlarged fluctuant lymph nodes (3.5-4.5 cm) in the left inguinal region above and below the inguinal ligament, forming a “groove sign” (red arrow, fig 1). Some of the lymph nodes had broken down and formed sinuses. He had oedema of the lower part of the left leg. No …

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