Q. Why did my 2-year-old son lose weight and have enlarged lymph nodes in the neck?

Answered by
Dr. Mubashir Razzaq Khan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 03, 2022

Hi doctor,

I have a two-year-old male child. He gets frequent colds and illnesses since infancy. He also took three courses of antibiotics to clear an ear infection. He has dropped from seventh percentile weight to third percentile weight, now gaining back to the eighth percentile. Weight loss and enlarged lymph nodes in the neck began eight months before. He is not interested in food, takes only a bite or two, and is supplemented with multi-vitamin, iron, vitamin D3, and a health drink. Bloodwork reports are, WBC- 2.5 x 109/l, RDW- 15 %, neutrophils- 0.9 x 109/l, lymphocytes- 1.3 x 109/l, moderate echinocytes (burr cells), reactive lymphocytes present, IgG- 10.20 g/L, total IgE- 122 kU/L. We are looking for a second opinion on what next steps we should take or what illnesses we need to explore or rule out. We are waiting for a referral to a hematologist, but waiting time is more here. If important will take him for faster exploration and treatment. Please help.



Welcome to

I understand your concern.

If we analyze your data, a raised IgE (immunoglobulin E) shows he has some allergies. Raised IgG (immunoglobulin G) shows, he has got recent infections. Low WBC (white blood cells) and low neutrophils are probably due to antibiotic-induced suppression, malnutrition, or related autoimmunity. Weight loss can also be linked to poor dietary intake. Echinicytes are seen in iron deficiency or as artifacts in samples. Unfortunately, the data provided is insufficient. I suggest you please send reports of CBC (complete blood count), ESR (erythrocyte sedimentation rate), reticulocytes, ALT (alanine transaminase), CRP (c-reactive protein), creatinine, and ultrasound of the abdomen and pelvis. For appetite, I suggest you give lysine containing multivitamin syrups.

I hope this helps.

Hi doctor,

Thanks for your reply.

I uploaded the recent blood work results (attachment removed to protect the patient’s identity). Unfortunately, I do not have additional information at this time. I am not familiar with what artifact in samples means. Does that change the implication of echinocytes? What may cause lymphocytes to be low and reactive lymphocytes present? The pediatrician mentioned considering leukemia with his hematology referral. Could that be a probable differential diagnosis, and is that a reasonable consideration based upon this bloodwork, weight loss, lack of appetite, and chronically enlarged lymph nodes? Please help.



Welcome back to

I understand your concern.

Echinocytes are a non-specific finding. It might also be seen in fever. So, it should be ignored. Lymphocytes are not low. It is at a fair level. Instead, neutrophils are low, indicating underproduction in the bone marrow. Other features, such as weight loss, can be related to poor food intake. Labeling it as leukemia is a diagnostic jump. I do not favor it. I suggest taking CBC, ESR, reticulocytes, ALT, CRP, creatinine, LDH, and ultrasound of the abdomen and pelvis for further diagnosis.

I hope this helps.

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