A 5-YEAR-OLD BLACK GIRL presented with a 9-month history of bilateral enlarging cervical adenopathy. She had intermittent fever, a 3-kg weight loss, poor appetite, difficulty swallowing, mouth breathing, and snoring with apneic pauses.
Physical examination revealed a thin girl with loud breathing and hyponasal speech. The ears and nose were unremarkable. The tonsils were 2+ bilaterally. There was no trismus. The neck examination revealed firm, nontender, massive bilateral cervical adenopathy (Figure 1). The patient had difficulty in turning her head, seemingly because of mass effect. Cranial nerve functions were clinically intact. Her chest was clear to auscultation. There was no palpable axillary or inguinal adenopathy, and there was no hepatosplenomegaly.