From the Guidelines
A 15-year-old with 10-pound weight loss and palpable cervical lymph nodes requires prompt medical evaluation, including a complete blood count (CBC) with differential, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to evaluate inflammation, as well as imaging studies such as chest X-ray and neck ultrasound or CT scan to evaluate the extent of lymphadenopathy and identify potential causes, as recommended by recent studies 1. The patient's symptoms, including weight loss and lymphadenopathy, are concerning and warrant thorough investigation, as they could indicate infection, autoimmune disease, or potentially malignancy such as lymphoma.
- The recommended laboratory tests include:
- Complete blood count (CBC) with differential to assess for infection or malignancy
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to evaluate inflammation
- Comprehensive metabolic panel to check organ function
- Thyroid function tests
- Epstein-Barr virus (EBV) serology
- Tuberculosis testing (PPD or QuantiFERON-TB Gold)
- HIV testing
- Additional tests may include lymph node biopsy if nodes are persistently enlarged or have concerning features, as suggested by studies on lymphoma diagnosis 1.
- Imaging studies, such as chest X-ray and neck ultrasound or CT scan, may be necessary to evaluate the extent of lymphadenopathy and identify potential causes, as recommended by the American College of Radiology 1. The patient should be evaluated by a pediatrician promptly, with possible referral to specialists depending on initial findings, and monitoring of symptoms, adequate nutrition, and hydration are important while awaiting results.
From the Research
Weight Loss and Laboratory Diagnosis
- A 15-year-old girl experiencing weight loss of 10 pounds may be related to various factors, including the use of stimulant medication for Attention-Deficit/Hyperactivity Disorder (ADHD) 2.
- The girl's weight dropped from 53 kg to 49 kg after starting stimulant medication, which may be a concern for an eating disorder 2.
Cervical Chain Lymph Node and Laboratory Diagnosis
- A palpable cervical chain lymph node may be an indication of a underlying infection, such as tuberculosis (TB) 3, 4, 5.
- Laboratory tests, including the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), can be used to diagnose latent TB infection 3, 4.
- A chest radiograph can also be used to evaluate for TB disease, especially in cases with a positive TST result 3, 5.
Laboratory Tests for Diagnosis
- The TST is the preferred test for latent TB infection, with IGRA as a supplemental test to improve specificity 3.
- The IGRAs are preferred in bacille Calmette-Guérin-vaccinated populations, while the TST is still used when cost or logistical advantages exist 4.
- A routine thoracic CT scan is not necessary for asymptomatic patients with only hilar lymphadenopathy findings in PA chest radiographs 5.