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An 18-year-old high school senior presents to her doctor with tender lymph nodes in her neck on the left side. She has no significant past medical history. Two weeks ago, she updated her vaccines in preparation for college. A lymph node biopsy is performed, which shows benign paracortical expansion and scattered multinucleated giant cells with eosinophilic cytoplasmic and nuclear inclusion bodies. Which of the following vaccines is most likely responsible for this woman's lymphadenitis?

A. Hepatitis B
B. Measles
C. Rubella
D. Smallpox
E. Tetanus
 

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Clues in the Q:

Paracortical area; a T cell area, it is live viral vaccine. Component, toxoid and killed vaccines stimulate B cells and germinal follicles. Choices B, E, and D (no longer in use, except for special military groups under threat of bioterrorism) are out.

Multi-nucleated cells; a paramyxo virus or herpes virus.

In preparation for college; MMR vaccine.

May be rubella or measles, but Multi-nucleated cells lead me to measles.

My choice B. Waiting for the explanation.

Good question: combines pathology, immunology and microbiology.
 

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good explanation by doctorF
The Warthin-Finkeldey (WF) giant cell described above is pathognomonic for measles or the live attenuated measles vaccine. Most giant cells are composed of histiocytes, but the WF giant cell is created by fusion of lymphocytes. Although postvaccinal lymphadenitis may be seen with different vaccines, the usual reaction is immunoblastic proliferation within the paracortical regions of a hyperplastic lymph node.

Hepatitis B (choice A), rubella (choice C), and tetanus (choice E) are rarely associated with postvaccinial lymphadenitis.

Smallpox (choice D) is classically followed by tender regional adenopathy, one to several weeks following immunization. There are no associated giant cells.
 

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An 18-year-old high school senior presents to her doctor with tender lymph nodes in her neck on the left side. She has no significant past medical history. Two weeks ago, she updated her vaccines in preparation for college. A lymph node biopsy is performed, which shows benign paracortical expansion and scattered multinucleated giant cells with eosinophilic cytoplasmic and nuclear inclusion bodies. Which of the following vaccines is most likely responsible for this woman's lymphadenitis?

A. Hepatitis B
B. Measles
C. Rubella
D. Smallpox
E. Tetanus
The Warthin-Finkeldey (WF) giant cell described above is pathognomonic for measles or the live attenuated measles vaccine. Most giant cells are composed of histiocytes, but the WF giant cell is created by fusion of lymphocytes. Although postvaccinal lymphadenitis may be seen with different vaccines, the usual reaction is immunoblastic proliferation within the paracortical regions of a hyperplastic lymph node.
 
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