AN 81-YEAR-OLD white man presented with a 5-day history of bilateral swelling in the submandibular region (Figure 1 and Figure 2). The patient initially presented to his primary care physician complaining of swelling in the right side of his neck and subsequently began amoxicillin–clavulanate potassium therapy (875 mg twice a day). Forty-eight hours later, his symptoms had not improved, and he developed swelling in the left submandibular area as well. On presentation to the otolaryngology clinic, he denied fevers, chills, night sweats, weight loss, loss of appetite, pain, or shortness of breath. His medical history was significant for atrial fibrillation, hypertension, and iron deficiency anemia. A bone marrow biopsy specimen obtained in December 1991 revealed normal red blood cell maturation, with no evidence of malignancy.
Swain R, Kingdom T, Muller S. Quiz Case 3. Arch Otolaryngol Head Neck Surg. 2000;126(9):1155. doi: