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Mano a Mano About Mono


I enjoyed the Photo Essay by Drs Alexander K. C. Leung and C. Pion Kao on infectiousdiseases in children (CONSULTANT, March 2001, page 459).

I enjoyed the Photo Essay by Drs Alexander K. C. Leung and C. Pion Kao on infectiousdiseases in children (CONSULTANT, March 2001, page 459). In one ofthe case studies, these authors described a 6-year-old girl with fever and a tender3-cm cervical mass (Figure); cervical lymphadenitis secondary to pharyngitis wasdiagnosed.

Infectious mononucleosis is also a common cause of acute cervical lymphadenitis.I would suggest it belongs in the differential.
-Natalie Kellogg, PA-C, MPH
  Ann Arbor, Mich

Thank you for your interest in our Photo Essay. We agree that infectiousmononucleosis is a potential cause of cervical lymphadenitis andhave emphasized this in previous publications.1,2 However, the clinicalfeatures and laboratory findings in this patient made infectiousmononucleosis unlikely. In particular, there was no rash orsplenomegaly. The peripheral smear showed toxic granulations in the whiteblood cells rather than atypical lymphocytes (Downey cells). The differentialcount showed neutrophilia rather than lymphocytosis (white blood cell countwas 15,000/µL with 74% neutrophils, 23% lymphocytes, 2% monocytes, and 1%eosinophils).

The differential diagnosis of cervical lymphadenitis is extensive.1 It wasbeyond the scope of this case study to present all the possibilities.

-Alexander K. C. Leung, MBBS, FRCPC, FRCP(UK & Ire), FRCPCH, FAAP
  Clinical Associate Professor of Pediatrics
  The University of Calgary - Faculty of Medicine
  Pediatric Consultant
  The Alberta Children's Hospital
  Calgary, Alberta
  C. Pion Kao, MD
  Pediatric Consultant
  The Alberta Children's Hospital
  Calgary, Alberta




Leung AK, Robson WL. Cervical lymphadenopathy in children. Can J Pediatr. 1991;3:10-17.


Leung AK, Pinto-Rojas A. Infectious mononucleosis. Consultant. 2000;40:134-136.

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