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Persistent Cervical Lymphadenopathy Caused by Foreign Body Ingestion With Migration Into Soft Tissue

A 3-year-old male was referred to the pediatric oncology clinic after failing management of persistent cervical lymphadenopathy. He initially presented 1 month earlier to his pediatrician and was treated with Augmentin for a suspected upper respiratory tract infection. He was previously healthy without any significant past medical or family history. On initial examination, a 2 to 2.5 cm hard, painless, mobile mass was palpated in the left posterior triangle of the neck with accompanying minor right anterior cervical lymphadenopathy. There were no other signs of infection and no restriction of neck movements. The rest of his physical examination was benign. Chest radiographs and hematologic laboratory values (including C-reactive protein, uric acid, and lactate dehydrogenase) were all within normal limits. On a follow-up visit, the mass had increased in size to approximately 3 cm. He remained clinically well, with no signs of infection, night sweats, or weight loss. Repeat chest radiographs were negative for mediastinal lymphadenopathy. He was referred to pediatric surgery for evaluation with regard to a possible neck biopsy and mass resection. An ultrasound of the neck was performed, which identified a nonspecific foreign body. A review of the earlier 2 X-rays showed that it was present at the same location. It was not present on a radiograph taken 2 years prior. Surgical resection was performed and a metal pen tip with surrounding capsule was removed. The patient had no postoperative complications and recovered well, with complete resolution of the cervical lymphadenopathy at his follow-up visit with the pediatric oncology service (Figures 1 and 2).