title: [Three children with general malaise, fever, weight loss and cervical lymphadenopathy].
abstract: Combinations of symptoms such as general malaise, fever, weight loss and cervical lymphadenopathy have extensive differential diagnoses. In three children, girls aged 11, 13 and 17 years who presented with these symptoms, three different diagnoses were obtained. The first had Hodgkin's disease, the second mixed connective tissue disease (MCTD), and the third Hodgkin's disease in combination with systemic lupus erythematosus (SLE). A systematic approach is necessary for the diagnosis of such conditions. Careful history taking can provide valuable information while a physical examination provides essential clues for the final diagnosis. In particular, nail-fold lesions, tendon nodules and signs of myopathy should be looked for in patients suspected of MCTD and/or SLE. In Hodgkin's disease, generalized or localised lymphadenopathy combined with a short history of extreme fatigue are the most important. Additional investigations should be individualized in order to minimise the diagnostic delay and make possible early treatment.
authors.affiliation: Afd. Immunologie, Hematologie, Oncologie, Beenmergtransplantatie en Auto-immuunziekten, Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden.
authors.forename: K C
authors.initials: KC
authors.lastname: Kraal
authors.forename: N
authors.initials: N
authors.lastname: van Paassen
authors.forename: L M
authors.initials: LM
authors.lastname: Ball
authors.forename: P M
authors.initials: PM
authors.lastname: Jansen
authors.forename: R
authors.initials: R
authors.lastname: ten Cate
mesh_terms: D000293:Adolescent; D002648:Child; D003240:Connective Tissue Diseases / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000209:etiology; D006689:Hodgkin Disease / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D008206:Lymphatic Diseases / Q000209:etiology; D015431:Weight Loss