FREDERIC B.ASKINMDWILLIAM H.WESTRAMD
A 25-year-old West Indian woman presented with a 4-week history of sore throat, intermittent fever, malaise, chills, maculopapular skin rash, patchy hair loss, and an enlarging painful lump on the right side of her neck. She denied having any other ear, nose, or throat symptoms. There was no loss of weight or appetite. She had no relevant medical or family history.
A 4 × 5-cm right posterior triangle lymph node and a 3 × 2-cm occipital node were evident on clinical examination. The findings of the rest of the ear, nose, and throat examination were normal. There was no generalized lymphadenopathy or hepatosplenomegaly. Routine blood tests showed a white blood cell count of 2.7 × 103/µL and an erythrocyte sedimentation rate of 116 mm/h. The results of radiography of the chest, thyroid function tests, and screening for infection and autoimmune disease were normal. Computed tomography of the head and neck revealed enlarged cervical lymph nodes (Figure 1).
Gopalan P, Kumar M, Aird DW, Williams W. Pathology Quiz Case. Arch Otolaryngol Head Neck Surg. 2004;130(10):1233-1234. doi:10.1001/archotol.130.10.1233