January 1995

Pathological Case of the Month

Author Affiliations

From the Department of Pediatrics, Texas Children's Cancer Center and Hematology Service (Drs Murray and Chintagumpala), and the Department of Pathology, Texas Children's Hospital and Baylor College of Medicine (Dr Rossman), Houston, Tex.

Arch Pediatr Adolesc Med. 1995;149(1):57-58. doi:10.1001/archpedi.1995.02170130059014

A PREVIOUSLY HEALTHY 7-year-old black girl presented with a 3-year history of slowly enlarging, painless, bilateral cervical, submandibular, and submental lymphadenopathy. She was asymptomatic except for occasional bouts of fever (temperature to 38.9°C) occurring every 2 to 3 weeks. There was no history of night sweats, weight loss, dysphagia, airway embarrassment, arthralgias, or rash.

Physical examination revealed an active and wellappearing afebrile girl with large, bilateral, nontender lymph node conglomerates in the anterior and posterior cervical chains and submandibular areas (Figure 1). Mild bilateral superior blepharoedema was also noted. No lymphadenopathy was detected by palpation in other regions, and results of the remainder of the examination were normal. A chest roentgenogram and complete blood cell count were normal, and the result of an intradermal purified protein derivative test (Mantoux) was negative. However, the erythrocyte sedimentation rate was prolonged at 54 mm/h (normal, <20 mm/h), and quantitative serum IgA and IgG

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