Unilateral Cervical Lymphadenopathy

Abstract

A 16-year-old girl presented with progressive left neck swelling of six weeks duration associated with low-grade fever and rash. Four weeks before visiting our institute, she was started on antibiotics combined with non-steroidal anti-inflammatory drugs (NSAIDs) prescribed by a doctor from a local health center. As a result, her pain resolved while the size of the swelling had an interval regression followed by rebound enlargement. Clinical examination revealed unilateral multiple non-tender enlarged left cervical lymphadenopathy involving level II to V with normal overlaying skin. The rest of her examination was unremarkable including upper aero-digestive endoscopy. These findings were demonstrated with further details with a computed tomography (CT) scan. She had mild microcytic hypochromic anemia with normal iron profile, folate, and B12. Further laboratory findings showed a white blood cell count of 4.0 × 10⁹/L, C-reactive protein (CRP) < 1 mg/L, erythrocyte sedimentation rate (ESR) 31 mm/hour, and lactate dehydrogenase (LDH) 288 U/L. An excisional biopsy of the swelling was taken for histopathological examination, which revealed areas of necrosis with histiocytic proliferation without granulomas. The histiocytes were positive for CD68 and myeloperoxidase (MPO).

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