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Diagnosis Detective - July 2024

July 1, 2024

Diagnosis Detective: Can you solve it?
Red Book Online Presents: Diagnosis Detective | July 2024

Editor: Kristina A. Bryant, MD, FAAP

Case contributed by Danielle Daniels, MD, FAAP, Pediatric Infectious Disease Fellow, SUNY Upstate Medical University, Syracuse, NY

A 2-year-old previously healthy male presents with a 5-week history of left-sided neck swelling. The swelling began as a painless, 3-centimeter lump on the left side of the neck. He was initially taken to an urgent care center where he was prescribed 10-day courses of oral cephalexin and trimethoprim-sulfamethoxazole, which he completed without improvement. Over the subsequent 2 weeks, the swelling has remained unchanged in size but the overlying skin has developed a reddish hue. The child’s caretaker denies associated fever, sore throat, nasal congestion, or cough. The family lives in central New York and deny any travel outside of the state or any animal exposure.

The child’s physical exam is notable for a mobile, non-tender 3-cm right submandibular lymph node with overlying erythema. There is no other lymphadenopathy, and the remainder of his physical exam is unremarkable.

Close up of a child's face with a large red swollen area near the lower chin and neck area.
Courtesy of Larry Frenkel, MD

© 2024 American Academy of Pediatrics. All rights reserved.

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