Over the years many amazing cases have been presented during the PEMPix presentation at the American Academy of Pediatrics’ annual national Conference and Exhibition during the Section on Emergency Medicine Sessions. PEMPix Classic is a new featured series on PEMBlog that will highlight some of those classic cases.
The Case
A six year old female with initial onset of right sided neck mass six months prior to presentation presents to the Emergency Department. At onset she was initially treated with a course of amoxicillin. It got better (for about two months) but then recurred and was treated with clindamycin and eventually an incision and drainage was performed. It was felt that the clindamycin had failed, and she was given a course of trimethoprim/sulfamethoxazole following the I&D. The wound culture was negative.
On the day of presentation to the Emergency Department her parents note that the swelling has again returned. They deny fevers or systemic symptoms (including no chronic cough, night sweats or weight loss). She has not been on any more antibiotics since completing the trimethoprim/sulfamethoxazole more than a month ago. There has been no drainage from the area, and parents note that the area around the I&D never quite healed, with a scab persistently present. They deny any significant exposures to HIV, known TB patients or kittens/cats.
Her physical exam is notable for a well appearing young lady with a nontender, erythematous fluctuant mass in the right submandibular region.
What is the diagnosis?
A. Cat-Scratch Disease
B. Cervicofacial actinomycosis
C. MRSA cervical adenitis
D. Scrofula
E. Branchial cleft cyst