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A 37-Year-Old Man Comes to the Office Due to a Week

question 361

Multiple Choice

A 37-year-old man comes to the office due to a week of sore throat. He also reports malaise but has had no fever, chills, nasal congestion, cough, or difficulty swallowing. Six months ago, the patient had similar symptoms and was found to have several cervical lymph nodes measuring 1.5-2 cm. Empiric antibiotic therapy was prescribed, and at follow-up 3 weeks later his sore throat had resolved and the lymph nodes were smaller. The patient has a history of hepatitis C for which he received treatment several years ago. He smokes a pack of cigarettes daily and drinks alcohol occasionally.
Temperature is 37.2 C (99 F) , blood pressure is 122/68 mm Hg, and pulse is 89/min. There is pharyngeal erythema and mild tonsillar enlargement. Three nontender anterior cervical lymph nodes are palpated, measuring approximately 3 cm each. There is a 0.5-cm right posterior cervical node. The liver span is 10 cm, and the spleen cannot be palpated. Physical examination is otherwise unremarkable.
Complete blood count, including peripheral blood smear, is unremarkable. Testing for HIV and rapid plasma reagin are negative. Symptomatic treatment is advised, and on follow-up 4 weeks later the patient reports his sore throat has resolved. The anterior cervical lymph nodes are decreased in size and now measure 1.5-2 cm.
Which of the following is the most likely cause of this patient's lymphadenopathy?

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