JAMA Pediatrics Clinical Challenge
An 18-Year-Old Man With Bilateral Violaceous Cervical Adenopathy
Erika V. Escobedo, MD
Cynthia H. Ho, MD
James D. Homans, MD, MPH
An 18-year-old Hispanic man residing in Los Angeles, California, presented with bilateral masses at the base of his neck, which he had for 2 months. The left-sided mass had been spontaneously draining straw-colored fluid for 5 days. Three months prior to presentation, he had received a diagnosis of pneumonia; his condition improved after a course of azithromycin. He denied ever having a fever, weight loss, contact with any sick persons, or sexual activity; using illicit drugs; or traveling outside of southern California.
Examination revealed mildly tender, fluctuant masses at the base of his neck, each measuring 4 cm in diameter (Figure, A). Laboratory values included a white blood cell count of 13/μL (to convert to ×109 per liter, multiply by 0.001) (69% neutrophils, 21% lymphocytes, and 2.3% eosinophils [to convert to proportion of 1.0, multiply by 0.01]), a hemoglobin level of 12.3 g/dL (to convert to grams per liter, multiply by 10.0), and a platelet count of 337 × 103/μL (to convert to ×109 per liter, multiply by 1.0). The results of a screening antibody test for human immunodeficiency virus and of a Mantoux tuberculin skin test were negative. A chest radiograph revealed bilateral hilar adenopathy (Figure, B). An excisional lymph node biopsy of the left-sided mass was performed (Figure, C).
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Author Affiliations: Escobedo, Ho (firstname.lastname@example.org), and Homans are affiliated with the Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine, Los Angeles, Ho is affiliated with the Department of Internal Medicine, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine, Los Angeles, and Homans is affiliated with the Division of Infectious Diseases, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine, Los Angeles.