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Clinical Challenge
Pathology
December 2018

An Unusual Entity Presenting as Bilateral Cervical Lymphadenopathy

Author Affiliations
  • 1ENT Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
JAMA Otolaryngol Head Neck Surg. 2018;144(12):1176-1177. doi:10.1001/jamaoto.2018.2361

A farmer in his 50s presented with bilateral periauricular swelling that began 6 months prior (Figure 1). The swelling was mild at onset and gradually progressive. There was no history of associated pain, but he reported occasional pruritus over the swelling. There was no history of fever, weight loss, or loss of appetite. He denied any history of similar swelling elsewhere in his body. General physical and systemic examination had normal results. On examination of the swelling on the right side, there was a diffuse swelling around the pinna measuring approximately 6 cm over the preauricular, postauricular, and infra-auricular region. It was a nontender, soft swelling without fluctuation and abnormal pulsations. There were similar findings in the left side. Mouth opening was adequate, secretions from both parotid ducts were normal, and facial nerve function was intact on both sides. He had undergone fine-needle aspiration cytology and incisional biopsy. The results of both were consistent with reactive lymphadenitis. He was prescribed oral antibiotics for 1 week but showed no improvement. A contrast-enhanced computed tomographic scan of the head and neck showed bilateral multiple enhancing lymph nodes in the postauricular region, the largest measuring 16 × 11 mm2 on the right side and 15.4 × 10.6 mm2 on the left, along with bilateral intraparotid nodes, the largest measuring 16.4 × 10.2 mm2 on the right and 15.3 × 10.7 mm2 on the left side. His serum eosinophil count was slightly elevated, and his erythrocyte sedimentation rate was 15 mm/h. However, the IgE level was not measured. He was then scheduled for excisional biopsy at our center. The biopsy specimen included skin and subcutaneous tissue along with 2 underlying lymph nodes.

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