Inguinal lymphadenopathy in an HIV seropositive patient

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 …