Question of the Week

For May 24, 2016

A 10-year-old girl presents for follow-up of cervical lymphadenopathy. She was initially evaluated 14 days ago for a left cervical lymph node that had been progressively enlarging for 10 days. She was treated empirically for lymphadenitis with a 14-day course of clindamycin.

Despite this treatment, the cervical lymphadenopathy has progressed. A 3-cm x 4-cm mass is palpable in the anterior cervical lymph-node chain. There is mild tenderness to palpation but no overlying erythema or fluctuance. There are no other enlarged lymph nodes or signs of systemic disease.

A purified protein derivative test was placed and found to be negative.

Which one of the following next steps is most appropriate in this patient’s care?

Perform a rapid test for streptococcal infection
Initiate a 5-day course of prednisone
Prescribe a 7-day course of amoxicillin–clavulanic acid
Refer for an excisional biopsy of the mass
Arrange for fine-needle aspiration of the mass