Viral hepatitis Quiz: Ace Your Exams

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A 62-year-old man presents to his primary care physician with weight loss, fatigue, and night sweats. He reports a progressive onset of symptoms over the past several weeks, and he has also noted the appearance of purplish, itchy, flat bumps on his forearms and legs. He also states his urine looks “darker” than usual. Past medical history is notable for diabetes mellitus and intravenous heroin use in his 20s. Temperature is 37°C (98.6°F), pulse is 63/min, respirations are 16/min and blood pressure is 134/72 mmHg. Physical examination is notable for a cachectic male in no acute distress, with submandibular and axillary lymphadenopathy, violaceous papules on the arms and legs, and 1+ pitting edema. Urinalysis is notable for 4+ protein without blood. He subsequently undergoes lymph node biopsy, which demonstrates  large, atypical B-cells with a high nuclear to cytoplasmic ratio consistent with diffuse large B-cell lymphoma, as shown below:



Reproduced from: Wikipedia

Which of the following pathogens is most likely associated with this patient’s clinical presentation?

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