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April 1994

Pathological Cases of the MonthCase 1

Arch Pediatr Adolesc Med. 1994;148(4):427-428. doi:10.1001/archpedi.1994.02170040093018

A 13-YEAR-OLD Korean boy had a 1-month history of recurrent fever, leukopenia, and bilateral cervical lymphadenopathy. One month prior to presentation, he had a 10-day illness: sore throat, abdominal pain, and daily fever spikes to 40°C. White blood cell count at that time was 2.2× 109/L (polymorphonuclear cells, 0.24; band forms, 0.37; lymphocytes, 0.32; and monocytes, 0.07). Throat culture for group A β-hemolytic streptococcus was negative, as were a slide agglutination test for heterophil antibodies to Epstein-Barr virus and testing for IgG- and IgM-specific serum antibodies to Epstein-Barr viral capsid antigen.

For 6 days prior to admission, temperature to 40°C and sore throat recurred; anorexia and fatigue developed.

He had lost 2.2 kg in the last month. On examination, his oral temperature was 39.0°C. He appeared tired but not acutely ill. He had bilateral anterior and posterior cervical lymphadenopathy; these soft, mobile, nontender lymph nodes were 0.5 to

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