Non-infectious unilateral cervical lymphadenopathy in children - a case report

Abstract

Cervical lymphadenopathy in children is often the reason to seek medical attention. According to the literature, 90% of children aged 4-9 years has cervical lymphadenopathy, mainly caused by acute infections, that is treated in the out-of-hospital setting. In a small, but significant number of cases, cervical lymphadenopathy is caused by malignancy and wide range of other clinical entities, that require more detailed clinical approach. Three patients with non-infectous unilateral cervical lymphadenopathy are presented; adolescent boy with unicentric Castleman disease, young adult with progressive transformation of germinal centers, and an infant with viral parotitis mistaken for cervical lymphadenopathy. Unicentric Castleman disease was diagnosed by pathohistological assesment of excised lymph node to a 14-year-old boy after 7 months of persistent cervical lymphadenopathy, and close follow-up was suggested as no disease progression was verified by PET- CT. Histopathological-clinical diagnosis of progressive transformation of germinal centers was established in an adolescent with 3-month history of lymphadenopathy, after extensive radiological and infectious assesment. Chronic reccurent course of the disease was once again confirmed, as this patient awaits his third extirpation in the last year. Viral parotitis is one of the conditions that can mimic cervical lymphadenopathy as showed with the third presented patient – a 6-month-old male infant with the submandibular swelling lasting for three days. This article emphasises the importance of a detailed history taking and clinical assesment, but is also a reminder of a less often, non- infectious causes of lymphadenopathy in children, where systematic approach is the key to a correct diagnosis and treatment.