Dx: Lymph Node Abscess vs. Burkett’s Lymphoma

I’ve never been so glad to see puss in my life. One of our friends recently brought her toddler to see us. The little girl, Chantal, had a firm mass on her neck, extending from the right side of her chin, to her right ear. The mass seemed to be originating from the mandible and was non-tender. Though she had a URI the week before and had been running fevers ever since, the mass did not seem to be an abscessed lymph node. We feared that Chantal had the most common type of childhood cancer here in Cameroon, Burkett’s Lymphoma. Though curable with chemotherapy, treatment would be impossible in the bush, and treatment in a hospital would be a logistical nightmare and quite traumatic for both child and mother. Non-compliance was probable, and without treatment, she would certainly die.
In desperation, we gave her some antibiotics and told the mother to continue hot soaks, hoping that we were wrong and it was, quite simply, an abscess. Two days later she came back, and we still had no answers, though we were happy to see that there was no detectable growth in the mass. Some further research revealed that Chantal did not fit the normal age parameters for Burkett’s Lymphoma, but we could not dismiss the possibility.
Once more she came back and we saw that the mass was coming to a fluctuant point that was now tender and reddened. With hope renewed, we performed an I&D. What a relief it was to see puss draining from this toddler’s neck. Unfortunately, after a painful procedure like that, it will be a long time before she ever trusts us again.