A not-so-innocent kiss

A 64-year-old man was admitted to the hospital with a 3-day history of fever. Two months earlier, he had experienced a similar ten-day episode of fever and nightly sweating during a trip to Hungary. Apart from tiredness and subtle weight loss over the last year, the patient was symptom-free. Relevant medical history included gout and a past infection with Epstein-Barr virus (EBV). The patient was febrile, 38°C, but further clinical examination was completely normal. Laboratory findings showed an elevated white blood cell count of 13.250/µL [4200 - 9800/µL] and a CRP of 190mg/L [0 - 3.2mg/L]. On CT scanning of the abdomen, a 5 cm long pathological wall thickening of the terminal ileum was noted [Figure A, arrow]. Colonoscopy confirmed the abnormal mucosal lining of the terminal ileum, showing a whitish polypoid nodularity [Figure B]. Biopsies were taken for histopathological examination [Figure C, Hematoxylin-eosin staining; Figure D, CD30 staining; Figure E, EBER staining].