It is normal for healthy children to have palpable lymph nodes in the anterior cervical, axillary and inguinal areas. The location of the enlarged lymph node can be helpful in the differential diagnosis. Enlargement of a lymph node (lymphadenopathy) may be caused by proliferation or invasion of inflammatory cells (lymphadenitis) or by infiltration of malignant cells. It is therefore important to understand the differential diagnosis, perform a thorough history and careful physical exam and be aware of the appropriate work up to undertake in a timely manner. However, some children with serious systemic disease or malignancy may present with lymphadenopathy. Fortunately, most of these children will have a benign, self-limited process. Lymphadenopathy is a common complaint that brings children to see a physician. She is discharged after 3 days of hospitalization to complete a 10 day course of penicillin. She responds to the antibiotics and I&D with dramatic improvement. Her antibiotics are changed to IV penicillin. Her throat culture also grows group A strep. Culture of the pus grows out Strep pyogenes (group A strep) within 24 hours. Gram stain shows numerous WBCs and gram positive cocci. A surgeon is consulted and the abscess is incised and drained (I&D) for a moderate amount of pus. An ultrasound study shows abscess formation. She is started on IV clindamycin empirically. CBC shows WBC of 25,000 with a left shift. Neurologic exam is normal.Ī throat swab is sent for beta hemolytic strep culture. No skin rashes or impetigo scars are noted. Her extremities are warm with full pulses and capillary refill time of one second. No hepatosplenomegaly or masses are noted. No axillary or inguinal lymphadenopathy is appreciated. There is a 2 cm x 3 cm tender, warm anterior cervical lymph node on the right with overlying erythema. Her neck is supple with tender bilateral cervical lymphadenopathy. Some clear nasal mucus is noted within her nares. Her throat is erythematous with patches of exudate on both tonsils. Sclera is white and conjunctiva are clear. She is tired appearing but in no acute distress. Height and weight are at the 50th percentile. Her past medical history, family history and social history are unremarkable.Įxam: VS T 40, P 110, RR 20, BP 80/40, oxygen saturation 100% in room air. There is no exposure to cats or other animals. Her history is negative for recent skin infection, skin rash, weight loss, dental problems or cavities, nausea, vomiting or diarrhea. No one at home has been ill but she does attend pre-school and several children have been ill recently with sore throats and URI symptoms. She has not been as active as usual and has not slept well due to the fever. Her appetite for solid foods is down but she is drinking fluids well and her urine output is normal. She is also complaining of a runny nose, cough and sore throat for 1 week. She has had 2 days of fever up to 104 degrees (40 degrees C). The mass started as a small lump that has enlarged to the size of a walnut and is now becoming painful, and warm to touch with overlying redness. Lymphadenitis and LymphangitisĪ 3 year old female presents to her primary care physician with a chief complaint of a neck mass that has been present and getting worse over 4 days. Case Based Pediatrics Chapter Case Based Pediatrics For Medical Students and Residentsĭepartment of Pediatrics, University of Hawaii John A.
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