Pain in the Neck

Tina Simpson, MD; Jean Ivey, DSN, CRNP; Melinda B. Cooling, MS, RN, CFNP

Disclosures

Pediatr Nurs. 2007;33(4):342-344. 

In This Article

History of Present Illness

Jacob is a 10-year-old boy who presented to an ambulatory clinic with a chief complaint of neck swelling.

Jacob had been evaluated in a local emergency room three times for swelling to the right side of the jaw. His mother stated he had a lesion near the right jaw line that looked like a "pimple" that became infected and then the swelling began. He was initially started on Keflex (Cephalexin) 250 mg three times daily for cellulitis. His condition did not improve and he was started on Augmentin (Amoxicillin/Clavulanate) 875 mg twice daily for 10 days. The anterior cervical region continued to stay enlarged and he developed adenopathy on the left anterior cervical side as well as an enlargement in the left supraclavicular area. Jacob then developed a low grade fever and the Augmentin (Amoxicillin/Clavulanate) prescription was extended to 14 days and his parents were instructed to follow up with his primary care provider. His CBC, rapid strep, and monospot were all normal, but he continued to have a low grade fever and pain when moving his neck. Jacob did not complain of sore throat, ear pain, vomiting, diarrhea, change in appetite, or malaise.

His past medical history includes asthma and ADD. Immunizations are up to date.

Jacob has many kittens at home that he enjoys playing with. His kittens often paw at his face leading to scratches while Jacob plays with them, but he has not had any previous infections from scratches.

His medications included Augmentin (Amoxicillin/Clavulanate) 875 mg twice daily and Concerta 36 mg daily.

Physical examination revealed a relatively healthy 10-year-old boy. Oral temperature was 98.6 F, respiration 20 breaths/minute, blood pressure 98/60, and a pulse of 88 beats/minute. The right side of the neck revealed a 10 cm x 5 cm area of cervical adenopathy that was tender to palpation, mobile, and without overlying inflammatory changes or increased local temperature. On the left side of the neck was a 7 cm x 7cm elongated adenopathy that was tender to palpation, mobile, and had increased local temperature. Additionally there was a healing 0.75 x 1 cm maculopapular lesion on the right jaw line. The remainder of the physical examination was normal.

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