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A 19-month-old Boy With Refractory Cervical Adenitis

Schneider, Anaïs MD*; Ranza, Emmanuelle MD; Diana, Alessandro MD*; Laurent, Méryle MD; Rougemont, Anne-Laure MD§; Hauri, Mathias MD, PhD; Reichenbach, Janine MD¶‖; Blanchard-Rohner, Geraldine MD, PhD*

The Pediatric Infectious Disease Journal: October 2019 - Volume 38 - Issue 10 - p 1071
doi: 10.1097/INF.0000000000002336
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From the *Department of Pediatrics, Children’s Hospital of Geneva

Service of Genetic Medicine

Department of radiology

§Division of clinical pathology, University Hospitals of Geneva, Geneva

Children’s Research Centre, University Children’s Hospital Zurich, Zurich

Institute for Regenerative Medicine (IREM)-associated group, University of Zurich, Zurich, Switzerland.

Accepted for publication February 6, 2019.

The authors have no funding or conflicts of interest to disclose.

Oral informed consent to publish the medical history of this patient has been given by the parents.

Address for correspondence: Geraldine Blanchard-Rohner, MD, Children’s Hospital of Geneva, 6 rue Willy-Donzé, 1211 Genève 14, Switzerland. E-mail: Geraldine.BlanchardRohner@hcuge.ch.

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THE CASE

A 19-month-old boy was admitted to our department with a 2-week history of fever and moderately elevated inflammatory parameters [C-reactive protein (CRP) of 70 mg/dL], persisting despite empirical treatment with amoxicillin/clavulanate. He was previously healthy, and his vaccinations were up to date. The family had no pets and had not traveled outside Europe. Physical examination revealed right cervical adenopathy (20 × 20 mm) without clinical signs of inflammation. The rest of the physical examination was unremarkable. Laboratory results showed a white blood cell count of 25 × 109/L, hemoglobin of 9.3 g/dL and platelet count of 553 × 109/L. CRP was 154 mg/L. Cervical ultrasound detected multiple enlarged lymph nodes bilaterally and a large fluid collection on the right side measuring 19.9 × 23 mm, compatible with an abscess. Intravenous (IV) amoxicillin/clavulanate (100 mg/kg/day) was administered, and the collection was surgically drained. Surgical cultures grew methicillin-susceptible Staphylococcus aureus. Despite antibiotic therapy and surgical drainage, the fever persisted, prompting further investigations. An abdominal ultrasound revealed multiple liver nodules, and magnetic resonance imaging showed multiple T2 hyperintense and T1 hypointense lesions in the liver with restricted diffusion, compatible with abscesses (Fig. 1). Ultrasound-guided biopsy of the liver nodules showed a focal fibroinflammatory process, suggestive of an infectious process. Cultures from the liver biopsy did not grow any organisms. Liver function tests were normal except for a transient moderate elevation of gamma-glutamyl transpeptidase. Bartonella henselae serology, interferon-gamma release assay, serum Aspergillus antigen, and culture and broad-range polymerase chain reaction of the blood were negative. An additional test revealed the underlying diagnosis.

FIGURE 1

FIGURE 1

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