Pediatric emergency medicine trisk 0917 0917

FIGURE 47.2 Lymph nodes of the body. (Reprinted with permission from Anderson MK. Foundations of
Athletic Training . 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.)

A third commonly encountered cause of cervical adenopathy in children and
adolescents is infectious mononucleosis caused by EBV, a herpes virus. EBV typically
causes bilateral anterior and posterior cervical lymph node swelling that is tender to
palpation. Nodes may be large and usually peak in size over the first week of illness,
gradually subsiding over the next few weeks. The classic presentation of mononucleosis
is a prodrome of malaise, headache, and elevated temperature prior to the development of
an exudative pharyngitis, tender cervical adenopathy, and fever. Splenomegaly, abdominal
pain, and anorexia may be present. Facial edema can accompany significant cervical
adenopathy, presumably reflecting obstructed lymphatic drainage. Younger children with
EBV infection may present less typically, with fever alone, symptoms of an upper