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July 1996

Neck Symptoms With Subtle Causes

Author Affiliations

Assistant Professor of Clinical Pediatrics Division of General Pediatrics-0641 University of California, San Diego School of Medicine 9500 Osler Lane La Jolla, CA 92093-0641

Arch Pediatr Adolesc Med. 1996;150(7):770. doi:10.1001/archpedi.1996.02170320116025

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The cause of a stiff and painful neck in a child is often elusive. Two cases of neck pain and stiffness associated with nonpalpable deep cervical adenopathy provide insight into situations where the cause of neck symptoms is uncertain.

Patient Reports.  Patient 1. A 16-month-old child presented with high-spiking fever lasting 2 weeks, neck pain and stiffness, and an evanescent rash consistent with systemic juvenile rheumatoid arthritis (Still disease). Imaging of the cervical spine by computed tomographic scan and magnetic resonance imaging showed multiple hypertrophied cervical lymph nodes. These were deep cervical nodes that were not palpable on physical examination.Patient 2. A 5-year-old child with Kawasaki disease presented with neck pain and stiffness. A computed tomographic scan of the cervical spine showed multiple hypertrophied cervical and submandibular lymph nodes. Again, this patient had no significant palpable cervical adenopathy, and no bony or soft-tissue abnormality was present on the scan.

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