From the Division of Adolescent Medicine, Department of Pediatrics (Dr Stahl), and the Division of Pulmonary Medicine, Department of Internal Medicine (Dr Cohen), Cook County Hospital, Chicago, Ill.
A 19-YEAR-OLD young adult had a 3-month history of body aches and a 1-month history of swelling of the left clavicle. He also reported fever, cough, and night sweats. The body aches included migratory pains in his left clavicle, lower ribs, lower back, right ankle, and upper arms. On physical examination, tender, warm, firm swelling of the left medial clavicle (Figure 1), right posterior lateral malleolus, and proximal left fibula were found. Findings from the remainder of the examination, including a slitlamp examination of the eyes, were unremarkable. Three weeks later, he developed bilateral parotid swelling that felt woody to palpation. Chest radiography findings were unremarkable except for marked hilar adenopathy. Additional studies included a technetium-Tc 99m bone scan (Figure 2) and computed tomography of the chest (Figure 3).
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The Rational Clinical Examination
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