Case 3: Fever and Lymphadenopathy in a 16-month-old Boy

1. Nehal Bhandari, MD* 2. Anjali Kirpalani, MD* 1. *Department of Pediatrics, Emory University, Atlanta, GA A 16-month-old boy with history of wheezing presents with fever and bilateral cervical lymphadenopathy. He was hospitalized 3 weeks ago with fever, pharyngitis, wheezing, and bilateral cervical lymphadenopathy. He was discharged home with the diagnosis of viral pharyngitis and right lower lobe pneumonia. He was treated with high-dose amoxicillin, prednisone, inhaled budesonide, and albuterol at that time. Bilateral cervical lymphadenopathy was noted on physical examination during this admission but was believed to be due to acute viral pharyngitis. After completing his courses of amoxicillin and prednisone, he presents today with a return of fever and progressively enlarging cervical nodes (Fig 1). Review of systems reveals cough, fussiness, and poor appetite. There is no history of sick contacts, cat exposures, or recent travel. Immunizations are up-to-date. Figure 1. Bilateral neck swelling on physical examination. On physical examination, the boy’s vital signs are within age-appropriate ranges. His weight is 10.4 kg (45th percentile) and length is 77 cm (15th percentile). He has markedly enlarged …