A 12-year-old female patient with no significant past medical history was admitted to the pediatric service due to hyperthermia and right laterocervical adenomegaly, with a three-week history of amoxicillin, with no response to the first antibiotic treatment.
Upon admission, the patient presented good general condition, daily hyperthermia and a right laterocervical tumor, irregular, hard, painful, with adjacent skin erythema.
The rest of the test was normal.
The laboratory showed leukopenia, without anemia or platelet count; and increased erythrocyte sedimentation rate and C-reactive protein.
Serology for cat scratch disease, Epstein-infection virus, cytomegalovirus, HIV, Bartonella, toxoplasmosis, Huddleson reaction, all hemocultives were requested.
Computed tomography of the neck and chest confirmed the presence of a homogeneous nodular formation in the right cervical region, without signs of adhesion, and ruled out thoracic involvement.
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After 7 days of hospitalization with intravenous antibiotics (ampicillin-the-sulphonate), and due to the lack of improvement of the clinical picture and the absence of an accurate diagnosis, surgical biopsy of the adenokuchimegaly was performed Kiji
The microscopic examination of the biopsy showed expansion of the paracortical area of the ganglion and follicular hyperplasia with histiocytes (CD68+) and immunoblasts (CD20+), with a background "stellate cell" appearance.
In the paracortex, necrotic foci with macrophages were also distinguished, phagocytosing detritus caricticos, with discrete mononucleosis surrounded by an abundant immunocytoblast.
No neutrophils were observed as part of the infiltrate.
The girl was admitted favorably and hyperthermia disappeared on successive days and was discharged on the fifth postoperative day.
After several episodes of isolated hyperthermia, the girl became normal.
