Case: AP180
Contributor's Comment: The classical features of syphilitic (luetic) lymphadenitis, namely follicular hyperplasia, plasmacytosis, multiple small non-caseating epithelioid granulomas, capsular inflammation and fibrous thickening, and vasculitis, are all present in this case. Although the Warthin-Starry stain did not reveal any spirochaetes, the patient was found to be serologically (VDRL and FTA) positive for syphilis after this possibility was conveyed to the clinician. Treatment resulted in disappearance of the lymph nodes and lowering of the serological test titres.
Most participants (except 369) labelled this case as granulomatous inflammation, advised some special stains for infective agents, and can score at least 90 marks. Those who mentioned Warthin-Starry stain or spirochaetes can get additional 5 marks. Since the WS stain was not rewarding in this particular case, a full mark is not granted if the possibility of syphilis is not specifically mentioned the diagnosis.