Case 3: Anterior Neck Swelling, Fever, and Hypertension in a 3-Year-Old Boy

Miranda Broadney; Rajan Senguttuvan; Priti G. Patel

doi:10.1542/pir.36-4-178

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Miranda Broadney, MD, MPH*
Rajan Senguttuvan, MD^†
Priti G. Patel, MD^‡

^*National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
^†Section of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, The University of Arizona, Tucson, AZ.
^‡Pediatric Endocrinology, Texas Tech University Health Sciences Center, El Paso, TX.

AUTHOR DISCLOSURE
Drs Broadney, Senguttuvan, and Patel have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Case Presentation

A previously healthy 3-year-old boy presents to the emergency department with a 5-day history of fever, sore throat, and progressive neck swelling despite treatment with antibiotics. Two days ago, he had presented to a community hospital emergency department for these symptoms and was prescribed azithromycin for presumed bacterial pharyngitis (no throat culture was obtained). Despite treatment, he now experiences a choking sensation and worsening pain in his neck.

His vital signs are notable for a temperature of 98.2°F (36.8°C), blood pressure of 140/103 mm Hg, heart rate of 170 beats per minute, and respiratory rate of 20 breaths per minute. His physical examination reveals a teary boy because of pain with normal work of breathing. His oropharynx has no erythema, and the tonsils are normal in appearance. He has marked erythema of the anterior lower neck with an exquisitely tender, indurated area that measures 6 cm in diameter and extends laterally from midline to the left. There is no fluctuation. Respiratory examination reveals a hoarse voice without stridor and clear lung fields on auscultation. Cardiovascular examination findings are notable for moderate tachycardia. The remainder of the examination findings are unremarkable.

Laboratory evaluation reveals a leukocyte count of …