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A four year old girl was brought to a clinician’s office because of lump at her left jaw for about two weeks. She did not have any fever, coughing, sore throat, or other respiratory symptoms. There was no cat exposure. The family have not traveled out of their state.

She was given amoxicillin/clavulinic acid for suspicion of infection of the lymph node at the jaw and neck area. Three weeks later the child was seen again because the swelling was getting bigger. There was no redness at the lump and there were no other enlarged lymph nodes in the neck.

She was referred to a surgeon for excision.

The biopsy report revealed the diagnosis.

Reference: Pediatrics In Review, June 1995, page 223

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Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.