<s>[INST] My grandson is 19 years old and has been c/o fatigue, muscle aches for months. Blood work : sed rate and Epstein Barr neg but had elevated wbc of 25,000 and after 2 courses of antibiotics the wbc is 25,000.  Enlarged lymph nodes in right axilla and groin. [/INST] He needs to know the cause of the symptoms, especially the elevated WBC and enlarged lymph glands before treating blindly with antibiotics. This could be an infectious process or even lymphoma. The infection could be an unusual one such as tuberculosis which would not respond to the usual antibiotics and requires extended therapy for months. At this point I think it is important that the lymph nodes are biopsied and cultured for unusual infections like TB and also the cells looked at to see if any type of cancer is present. He might need a bone marrow biopsy to see why the WBC are so high. This deserves prompt in-depth evaluation to figure out the cause. Hope this helps. </s>