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Am Fam Physician. 2022;105(4):423-424

Author disclosure: No relevant financial relationships.

An 11-month-old girl presented with a four-day history of fever and a mass on her neck. She had been diagnosed with hand-foot-and-mouth disease one week earlier. The patient had no recent animal exposure or travel. She had never experienced a similar episode and had no recent weight loss.

Physical examination revealed a mildly fluctuant mass in the lower end of the right posterior cervical triangle (Figure 1). The mass was warm to the touch and erythematous. The patient showed signs of irritation when the mass was palpated. She had no associated pharyngitis, hepatosplenomegaly, or other discernable masses. Ultrasonography was performed (Figure 2).

Question

Based on the patient’s history and physical examination findings, which one of the following is the most likely diagnosis?

  • A. Infectious mononucleosis.

  • B. Kawasaki disease.

  • C. Kikuchi-Fujimoto disease.

  • D. Lymphangioma.

  • E. Staphylococcal lymphadenitis.

Discussion

The correct answer is E: staphylococcal lymphadenitis. Ultrasonography of the neck lesion demonstrated a hypoechoic mass with thickening of the surrounding soft tissue. A fine needle aspiration of the mass confirmed Staphylococcus aureus infection, the most common cause of bacterial lymphadenitis. Staphylococcal cervical lymphadenitis typically affects preschool-aged children.1 A unilateral lesion occurs in 90% of children with the condition.2

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The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at https://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. Email submissions to afpphoto@aafp.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz

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