Suggest treatment for lethargy and painful cervical lymph nodes in a child
Patient: HI, my 3 year old son has been ill for 9 months, it started with a virus as such. He suffers with occasional night sweats and a fever every 21-28 days. He has a poor appetite although we do make him eat, he drinks plenty of fluids. He is lethargic and tired and is unbearably tired by friday. He looks washed out and tired. The last letter from our consultant stated He has persistent 1.5cm mobile shotty cervical lymph nodes and inguinal lymph nodes present on the right side of his nec, but with no obvious hepatosplenomegaly or masses. His abdo is soft and non-distended and no abnormalities of gait or limp are present. His bloods & tests include a -ve bone scan, normal AP xray of pelvis and chest, normal abdo ultrasound. His FBC shows mild microcytic anaemia, his HB 11.9, MCV 78, Ferritin 13, with slight lymphcytosis up to 5.2 x10*9/L, but a normal film. -ve serology for toxoplasma coeliac and ANA, normal u&e, LFTS, CK and thyroid and glucose Our consultant is saying its is post viral fatigue, but after 9 months ? could this really be the answer. Our 3 year old is now hoarse and complaining of pain where the glands are swollen. Can you offer any further advice ? many thanks in advance Doctor: Hi,From history it seems that he might be having possibility of Primary complex producing long lasting fever, generalized lymphadenitis, weakness and fatigue.He might require, Montoux test,Complete blood checking with ESR.After investigations one can have some clue about his chronic fever.Consult pediatrician and get examined.Ok and take care.