Toxoplasmosis in an Immunocompetent Child - An Unusual Cause of Cervical Lymphadenopathy

Abstract

A young, previously healthy child presented with progressively increasing painless swelling in left side of the neck for one month. There was no history of TB contact, fever or any other constitutional symptoms. On examination, level V cervical lymph node was enlarged, approximately 2 x 2 cm size, which was mobile and non-tender. There was no other lymphadenopathy or hepatosplenomegaly. Routine blood investigations were within normal limits. Swelling progressed in size in-spite of treatment with multiple courses of oral antibiotics. Excision biopsy of the lymph node was done and histopathology showed lymph node follicles with reactive germinal centres and interfollicular area showing small collections of epitheliod histiocytes (micogranuloma) and monocytoid cells, suggestive of toxoplasma lymphadenitis. IgM toxoplasma serology was also positive, which confirmed the diagnosis. Fundus examination, CT Brain and USG abdomen were normal, ruling out any other organ involvement.  Child was worked up for primary and secondary immunodeficiency. Lymphocyte subset, immunoglobulin profile and NBT-DHR were normal. Tuberculosis workup and HIV serology were negative. In view of the immunocompetent status, child was not given any specific medications. Post excision, child has remained asymptomatic on three months follow-up.