Cervical lymphadenitis may have multiple etiologic factors and can pose a diagnostic dilemma for pediatric hospitalists. This case and review of the literature explores various causes, diagnostic methods, and treatment options available to the pediatrician caring for children with lymphadenitis.

An 18-month-old male infant originally presented with swelling in the right neck near the angle of the jaw which gradually developed over 4 to 5 days. He was first taken to his primary care provider who noted multiple enlarged, nontender, submandibular lymph nodes and prescribed amoxicillin. However, because of increasing swelling after several days of antibiotic use, the patient was taken to the emergency department where he was prescribed, and completed, first a 10-day course of amoxicillin/clavulanate, and subsequently, a 7-day course of azithromycin. The patient’s neck swelling failed to improve, though he never developed significant fever or prominent tenderness.

Is the patient’s clinical course up to this point suggestive...

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