A 22-year-old healthy woman.
Sepsis was due to a 3-month history of sensitive cervical-parotid enlargement refractory to medication.
It was interpreted as infectious mononucleosis syndrome and due to its persistence amoxicillin-clavulanic acid was empirically indicated without clinical improvement.
Finally, glucocorticoids were indicated with complete resolution.
Two months later she consulted again for fever associated with multiple sensitive and indurated submandibular adenopathies, with increased ipsilateral parotid volume.
The patient had a CRP level of 41 mg/L and a complete blood count with a relative neutrophilia.
Liver tests and LDH were within normal ranges.
Cervical CT was requested, which showed an increase in parotid volume and bilateral cervical ganglion groups, both of right predominance.
A probable cervical flegmon was also reported.
Antibiotics (ceftriaxone plus clindamycin) were restarted without response.
Given the persistence of the clinical picture, a second-line antibiotic scheme (vancomycin plus levofloxacin) was escalated with a chest-abdominal-pelvis CT scan with no other precarinal lymph node findings.
Immunological study with ANA and infectious for EBV, CMV, HIV, syphilis, Toxoplasma gondii and Bartonella hensenlae were negative.
Finally, cervical lymph node biopsy revealed findings consistent with histiocytic necrotizing lymphadenitis.
Antibiotics were suspended and treatment with prednisone 30 mg/day was indicated, with progressive dose reduction from the second week, completing 1 month of treatment.
Fever subsided 24 h after initiation of therapy and did not recur at 6 months follow-up.
