Prepared by Amir Mohammad, MD, Resident, Claudia McClintock, MD, Assistant Professor, and Keith vom Eigen, MD, Assistant Professor, Department of Internal Medicine, University of Connecticut Health Center, Farmington

A 25-year-old Nepalese woman presented to a primary care clinic complaining of right-sided neck pain, swelling, and fever for the past 3 weeks. She had no known allergies and denied any chills, cough, night sweats, and weight loss. Physical examination revealed a 3-cm tender, palpable mass below the angle of the jaw, along with palpable nodes in the inferior and posterior cervical chains. She was afebrile. Complete blood cell count showed: leukocyte count, 3.1 x 10⁹/L, with 14% neutrophils; bands, 14%; lymphocytes, 41%; monocytes, 19%. Tests for viral infection were negative. Magnetic resonance imaging of the neck (Figure 1) and right cervical lymph node excisional biopsy for definitive diagnosis (Figures 2, 3) were performed.

What’s Your Diagnosis?

Sarcoidosis

Kikuchi’s disease

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Castleman’s disease