2/2007Limphadenopathy diagnostics based on a case of Hodgkin’s disease in 11-year-old boy

WOJCIECH JAROSZEWSKI (Katedra i Zakład Lekarza Rodzinnego Collegium Medicum im. L. Rydygiera w Bydgoszczy,Uniwersytet im. Mikołaja Kopernika w Toruniu;p.o. Kierownik: dr n. med. Krzysztof Buczkowski )

Background
The difficulties that a general practitioner faces during limphadenopathy diagnostics in children are laid out in the case study. In the introduction, the specificity of Hodgkin’s disease, a disease entity was described. Incidence coefficients, basics of diagnostics and classification were presented, and attention was drawn to the therapeutic possibilities as well as complications in treatment. Further on, the case of an 11-year-old boy, who reported to a general practitioner because of recurrent fever without significant symptoms of the respiratory system, was analysed. The lymph glands in the neck, which were perceptible, were not bigger than 1 cm in diameter and could be considered physiological, but the general symptoms (feverish states) and deviations in basic laboratory tests (accelerated sedimentation rate, hepatomegaly and splenomegaly in the ultrasonography) caused the doctor anxiety and made him do more in-depth diagnostics. Having made otolaryngological examination (tomography of the sinuses and sinusoscopy) and ruled out possible infection (serological markers, cultures) and rheumatology causes, the doctor decided to take the gland for histopathology examination. The doctor’s increased anxiety was justified by the ultimate diagnosis of Hodgkin’s disease. In the discussion, the basic rules for differentiating inflammatory and neoplastic enlargement of the lymph glands with particular reference to the specificity of children’s age were put forward. In the physical examination, the lymph gland size, their location, and consistency ought to be taken into account. Of equal importance are those symptoms accompanying gland pathology. At the end of the discussion, attention was drawn to late complications in treating Hodgkin’s disease.

Material and methods
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Results
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Key words: general practitioner, Hodgkin’s disease