An 11-year-old boy with a medical history of allergic rhinitis presented to the emergency department of a children’s hospital with 2 weeks of painful left-sided neck swelling and fever. He had accompanying night sweats, fatigue, and decreased appetite. Initial physical examination revealed multiple distinct matted, firm left-sided cervical lymph nodes.
Laboratory evaluation was notable for leukopenia with a white blood cell count of 3700/µL (to convert to 109/L, multiply by 0.001), a microcytic anemia with a hemoglobin of 10.7 g/dL (to convert to g/L, multiply by 10), mean corpuscular volume of 58 µm3 (to convert to fL, multiply by 1), an elevated lactate dehydrogenase level of 548 U/L (to convert to µkat/L, multiply by 0.0167), and an elevated erythrocyte sedimentation rate of 35 mm/h. Purified protein derivative and infectious mononucleosis testing were negative.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Morgan P. Brown, BSPH, University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME 04005 (email@example.com).
Published Online: November 16, 2023. doi:10.1001/jamaoto.2023.3669
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient’s guardian for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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