Enlarged submandibular node

[Miracoli]

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A 4-year-old child presents with an enlarged submandibular node that is 4 cm in diameter, non-tender, and not fluctuant. The node has been enlarged for about 4 weeks and there is no history of fever or contact with any person who was ill. A complete blood count (CBC) is normal, and a Mantoux test with 5 tuberculin units of purified protein derivative shows 6 mm of induration. Which one of the following is the most likely diagnosis?
a) cat-scratch fever
b) acute pyogenic lymphadenitis
c) acute lymphoblastic leukemia
d) tuberculous lymphadenitis
e) atypical mycobacteria lymphadenitis

 

[dyspareunia]

E?

 

[CherryRedDracul]

I'd narrow the choices down to C and E because the others would cause painful lymphadenopathy. C is possible because ALL can cause painless enlarged nodes, but the CBC wouldn't be normal. That would leave only E as a choice. Sounds like scrofula?

 

[dyspareunia]

I'd narrow the choices down to C and E because the others would cause painful lymphadenopathy. C is possible because ALL can cause painless enlarged nodes, but the CBC wouldn't be normal. That would leave only E as a choice. Sounds like scrofula?

And cat scratch is more commonly axillary nodes with low grade fever.

 

[tantacles]

And cat scratch is more commonly axillary nodes with low grade fever.

AND it wouldn't have a positive tuberculin test, which I think was the real clue to the question.

 

[notbobtrustme]

I'd go with C, but this is a dick question if the answer is A without giving us either bug or history.

 

[GadRads]

CBC is normal per question, So E.

 

[thehundredthone]

AND it wouldn't have a positive tuberculin test, which I think was the real clue to the question.

The test is not positive. Even with exposure to a person with TB, in children less than 4, the cutoff is 10mm of induration. In a population with no risk factors for TB, the cutoff is 15mm of induration.

 

[dyspareunia]

AND it wouldn't have a positive tuberculin test, which I think was the real clue to the question.

6mm isn't positive. If the skin test was positive then the answer would probably be D.

 

[tantacles]

6mm isn't positive. If the skin test was positive then the answer would probably be D.

ooooo, you are correct. In children less than 4, 10 mm is positive. Anyone over the age of 4 with no risk factors? 15 mm.