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A nine year old girl was brought to a clinician’s office because of neck swelling for one week. She did not have other symptoms like fever, poor appetite, sore throat, difficulty of swallowing, runny nose, nausea, or coughing. In her previous office visit, she was diagnosed to have beta thalassemia minor (a red blood cell disease). All of her immunizations were complete. At the office, she did not appear ill with a temperature of 37.2 C (normal). The clinician found painful enlarged lymph nodes under the jaw. The size of the lymph nodes was about 1.5 centimeter. The tonsil has white spots (exudate). A throat culture was done and amoxicillin was started. The throat culture showed Streptococcus (Group A beta-hemolytic). Five days later she was back because of persistent sore throat and feeling tired. Red spotty rashes were seen on her trunk, arms, and legs. She did not have fever and still did not look sick. Different Causes of Enlarged Lymph Nodes Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.
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