INTRODUCTION

Fareed, a 15-year-old British boy of Pakistani origin, was brought to his general practitioner (GP). His parents had become concerned about a ‘lump’ which had recently appeared on his neck and had now been present for approximately 2 weeks. Fareed had been unwell in the last fortnight with a history of a mild fever, coryzal symptoms and a sore throat. These symptoms had resolved although he was still feeling quite tired. There was no history of night sweats, weight loss or pruritus and he had not noticed any unusual lumps in other places.

There was no significant past medical history. Fareed was fully immunised. He was not taking regular medication and had no allergies. His parents were originally from Pakistan but he had never been abroad. There was no history of diseases in the family and no contacts with tuberculosis. There were also no pets.

On examination Fareed appeared well. His height (170 cm, just above 50th centile) and weight (63 kg, just below the 75th centile) were recorded. There was no pallor, jaundice or petechiae. His pharynx was a little inflamed and he had mildly enlarged tonsils without exudate. A 2.5-cm lymph node was palpable in the left posterior triangle of the neck. This was firm, mobile and mildly tender, but there was no inflammation or induration of the overlying skin. There were no other palpable nodes in the neck, supraclavicular fossa, axillae or groin and no hepatosplenomegaly.

After considering the clinical presentation and examination findings, a diagnosis of reactive lymphadenopathy was made. In the absence of any signs of significant bacterial infection, supportive care was recommended. A throat swab was sent to rule out Group A streptococcal infection. In view of the 2.5 cm lymph node, review was planned in 3 weeks.