On initial evaluation the results of the physical examination were normal except for a nontender 1×1×1-cm left axillary lymph node. The liver and spleen were not enlarged. Laboratory data included the following values: white blood cells, 8.8×109/L, with 0.60 neutrophils, 0.29 lymphocytes; erythrocyte sedimentation, 84 mm/h; alkaline phosphatase, 168 U/L; alanine aminotransferase, 37 U/L; γ-glutamyltranspeptidase, 37 U/L; lactate dehydrogenase, 785 U/L. Findings were negative for heterophile antibody analysis; normal, urinalysis;negative, rheumatoid factor; negative, antinuclear antibody; negative, serology for cytomegalovirus; and normal, chest radiograph. Results of blood, urine, and throat cultures were negative for organisms.