QUESTION: My son has had a swollen lump on his neck for about 3-4 weeks. I took him to the ER on March 20th and was told his lymph nodes are swollen so he has an infection they are fighting and was sent home with PO clindamycin 300mg 3x a day for 7 days. We went back to the ER this pass Saturday and the problem was worse. They gave him IV clinda @ 600 mg then Unasyn and admitted him into the children's hospital for two days and the swelling did not decrease. They did several tests, mono was negative, But a few levels was elevated his ALT and monocytes. He was sent home from the hospital. What could have caused this and the elevated test results?

ANSWER: Hi, Christian,

Lots of healthy kids have dramatic increases in nodes with or after an infection.  I think the use of clindamycin in the ER, unless the node was huge and tender, was perhaps a bit hasty, although I wasn't there and didn't see him or get the history.

If he was admitted by a Childrens Hospital, they must have felt the node was infected and unusual.  The ALT can be higher in kids than adults and to interpret this and the monocyte count, I would need exact numbers.  

The large nodes could be due to viral, bacterial or fungal infection or be sign of another illness that could cause large nodes. Your pediatrician would be able to look at all the data, and tell you what was going on.  Always happy to help.

Good luck, D.r Olson

---------- FOLLOW-UP ----------

QUESTION: Good afternoon,
Since your response my son's  Bartonella Henselae was elevated indicating cat scratch disease but his ACE level was also elevated at 117.


Cat Scratch disease is probably what is going on and this is either self-limited or is sometimes treated.  I am not aware of the ACE level. Tell me more about that.

Good luck, Dr. Olson

On further looking, and I didn't know this, ACE levels tend to be high in CSD.  I think this all fits neatly into the package of cat scratch disease.  I have never ordered an ACE test in my pediatric life, and seems to be helpful mainly in cases of pediatric sarcoidosis, something I personally have seen just once or twice.


All Answers

Answers by Expert:

Ask Experts


David Olson, MD


I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

©2017 All rights reserved.