A 14-year-old African American boy presents with fever, right-sided neck swelling, and weight loss of 20 lb over 2-month period. He denies night sweats, illness contacts, or recent travel. He was seen 1 month ago for fatigue, body aches, decreased appetite, and 10 lb weight loss over the previous month. Due to a family history of diabetes, urinalysis was performed, which revealed moderate hemoglobin, protein of 200 mg/dL, white blood cell (WBC) count of 13/high power field, and red blood cell (RBC) count of 5/high power field. He was scheduled to be re-evaluated in 1 week but has been lost to follow-up.

The boy appears tired. His weight is 54.2 kg (>50th percentile), height is 165 cm (75th percentile), temperature is 38.9°C, heart rate is 106 beats/minute, respiratory rate is 20 breaths/minute, and blood pressure is 113/64 mm Hg. Physical examination reveals a 3 × 4 cm, tender, nonerythematous, nonfluctuant,...

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