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Dr. Andrew Rynne

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Child has mild fever, swollen lymph node in armpit and loss of appetite. Proper diagnosis?

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Dr. Uma Rajah Ananth

Pediatrician, Neonatology

Practicing since :1970

Answered : 891 Questions

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Posted on Fri, 1 Mar 2013 in Child Health
Question: In August my 2.5 yr old daughter would tire easy and breath funny. We noticed she had swollen lymph nodes in her armpit when we went to take her temperature. She has had mild fever off and on. She stopped sleeping through the night. So we thought maybe she had mono or something. The doctor said that since she had no other signs of being ill to wait a few weeks. We brought her back and she was the same so he took bloodwork which all came back normal. He said to bring her back in another month if she still wasn't better. This time he said that she lost 3lbs since Aug and now weighs 26lbs (we took her a week ago). She has never been a 'good' eater but never lost weight before. Still no sore throat, sinus or ear infection, no coughing. Her doc is sending her to an infectious disease doc. had more bloodwork done (WBC =13 and SED rate = 26). This week she is eating even less than usual. The doctor ordered her an anti-biotic (bactrim) and she is now eating very small amounts. Should we be concerned? What other tests might they order? If it were infectious disease, woudln't she show other symptoms? Her appt with the infectious doctor is 12/11. What should we expect and how long should we allow this guessing game to go on?

This is the some of what her doctor described in the referral: referred to for Infectious diesease at childrens diffuse lymphadenitis, neck, axilla

doctor
Answered by Dr. Uma Rajah Ananth 38 minutes later
Hi.
Thanks for the details!

To summarise your child has :
Axillary and cervical lymphadenitis
Loss of appetite
Loss of weight.
No fever ,cough or other systemic signs.

The possibilities are

viral infections like CMV
Tuberculosis

I understand your concern with the guessing game!
Some diseases are straight forward, others are not!

What she will need is a fine needle aspiration biopsy of the lymph node and some blood tests for viruses and tuberculosis and mantoux test.

Do not worry.
God bless
Dr Uma


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Uma Rajah Ananth 50 minutes later
Thank you for the quick response Dr. Uma.

She has had a low grade fever since August most days. She also complains of leg and eye pain (I forgot to mention that earlier.)

I do have a question about a fine needle aspiration. Does this check for conditions that are not infectious in nature? I am concerned that if those viral illness and TB infections you mentioned are not present that she would have to undergo this procedure again. Is it painful?
doctor
Answered by Dr. Uma Rajah Ananth 1 hour later
Hi,
I under stand your feelings!

Tuberculosis and viral infections can be determined by blood tests 'mantoux test etc also.
Biopsy will show both infective and other non infective causes in more detail.
As the name suggests it is a fine needle aspiration.

They will give a local anesthesia to prevent pain.
Do not be scared.
God bless
Regards
Dr Uma
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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