Free practice question · USMLE Step 1
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A 58-year-old man presents with a 3-month history of progressive, painless cervical and axillary lymphadenopathy, drenching night sweats, and weight loss. Imaging reveals widespread nodal involvement above and below the diaphragm. Excisional lymph node biopsy demonstrates scattered large cells with bilobed nuclei and prominent eosinophilic inclusion-like nucleoli, set within a rich background of T lymphocytes, macrophages, and eosinophils. During his evaluation, he develops oral mucosal bleeding and scattered petechiae. Laboratory studies show a hemoglobin of 13.2 g/dL, leukocyte count of 7,500/mm³, and platelet count of 14,000/mm³. A peripheral blood smear shows enlarged platelets and no blasts.
Which of the following conditions is the most likely cause of this patient's bleeding and petechiae?
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