Progressive Unilateral Cervical Lymphadenopathy With Elevated LDH in a School-Aged Female

Abstract

An 8-year-old previously healthy female presents with a 2-week history of an enlarging tender right-sided neck mass. The swelling was initially pea-sized, but over the 3 to 4 days immediately preceding her admission, the mass was noted to be enlarging. She had been seen 2 days prior to admission by her pediatrician and was prescribed sulfamethoxazole/trimethoprim, which she had been taking without improvement. In the 24 hours prior to admission she developed fever as high as 104°F, had decreased oral intake, and was complaining of neck pain. The patient had never been hospitalized before, had no known medical problems, and had no history of prior surgeries. Family history was significant for postural orthostatic tachycardia syndrome in the mother and paroxysmal atrial tachycardia in the father. The patient was in second grade, was very active, and was on the swim team. She had recently had contact with new kittens at her grandmother's home.On initial examination the patient appeared ill but nontoxic. She had a 3-cm firm mobile mass located just beneath the pinna of her right ear with associated swelling, overlying erythema, and mild tenderness with palpation located in the upper anterior cervical chain. There was no fluctuance. She had slightly decreased range of motion of her neck when turning to her right. A <0.5 cm right supraclavicular lymph note was also appreciated. The remainder of the exam was normal.