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Lymphadenitis Clinical Presentation

  • Author: Elizabeth Partridge, MD, MPH; Chief Editor: Russell W Steele, MD  more...
 
Updated: May 11, 2015
 

History

Patients with a clinical history of any of the following may be at risk for developing lymphadenitis:

  • Symptoms of an upper respiratory tract infection, sore throat, earache, coryza, conjunctivitis, or impetigo
  • Fever, irritability, or anorexia
  • Contact with animals, especially kittens or livestock
  • Recent dental care or poor dental health
  • Recent use of hydantoin and/or mesantoin
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Physical

Enlarged lymph nodes can be asymptomatic, or they can cause local pain and tenderness. Overlying skin may be unaffected or erythematous.

Cervical lymphadenitis can lead to neck stiffness and torticollis.

Preauricular adenopathy is associated with several forms of conjunctivitis, including unilocular granulomatous conjunctivitis (catscratch disease, chlamydial conjunctivitis, listeriosis, tularemia, or tuberculosis), pharyngeal conjunctival fever (adenovirus type 3 infection) and keratoconjunctivitis (adenovirus type 8 infection).

Retropharyngeal node inflammation can cause dysphagia or dyspnea.

Mediastinal lymphadenitis may cause cough, dyspnea, stridor, dysphagia, pleural effusion, or venous congestion.

Intra-abdominal (mesenteric and retroperitoneal) adenopathy can manifest as abdominal pain.

Iliac lymph node involvement may cause abdominal pain and limping.

Aspects of the physical examination are as follows:

  • Location - Depends on underlying etiology (see Table below)
  • Number - Single, local groupings (regional), or generalized (ie, multiple regions)
  • Size/shape - Normal lymph nodes range in size from a few millimeters to 2 cm in diameter; enlarged nodes are greater than 2-3 cm with regular/irregular shapes
  • Consistency - Soft, firm, rubbery, hard, fluctuant, warm
  • Tenderness - Suggestive of an infectious process but does not rule out malignant causes

Physical examination findings suggestive of malignancy are as follows:

  • Firm
  • Hard
  • Fixed
  • Nontender

Physical examination findings suggestive of infection are as follows:

  • Soft
  • Fluctuant
  • Tender
  • Overlying erythema or streaking
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Causes

Infectious agents/causes and lymphadenitis characteristics are as follows[2] :

  • Bartonella henselae (catscratch disease) – Single-node involvement determined by scratch site; discrete, mobile, nontender
  • Coccidioides immitis (coccidioidomycosis) – Mediastinal
  • Cytomegalovirus – Generalized
  • Dental caries/abscess – Submaxillary
  • Epstein-Barr virus (mononucleosis) - Anterior cervical, mediastinal, bilateral; discrete, firm, nontender
  • Francisella tularensis (tularemia) - Cervical, mediastinal, or generalized; tender
  • Histoplasma capsulatum (histoplasmosis) – Mediastinal
  • Atypical Mycobacterium - Cervical, submandibular, submental (usually unilateral); most commonly in immunocompetent children aged 1-5 years [3]
  • Mycobacterium tuberculosis - Mediastinal, mesenteric, anterior cervical, localized disease (discrete, firm, mobile, tender); generalized hematogenous spread (soft, fluctuant, matted, and adhere to overlying, erythematous skin)
  • Parvovirus - Posterior auricular, posterior cervical, occipital
  • Rubella - Posterior auricular, posterior cervical, occipital
  • Salmonella – Generalized
  • Seborrheic dermatitis, scalp infections - Occipital, postauricular
  • Staphylococcus aureus adenitis - Cervical, submandibular; unilateral, firm, tender
  • Group A streptococcal (GAS) pharyngitis - Submandibular and anterior cervical; unilateral, firm, tender
  • Toxoplasma gondii - Generalized, often nontender
  • Viral pharyngitis - Bilateral postcervical; firm, tender
  • Yersinia enterocolitica - Cervical or abdominal
  • Yersinia pestis (plague) - Axillary, inguinal, femoral, cervical; extremely tender with overlying erythema

Immunologic or connective tissue disorders causing lymphadenitis are as follows:

Primary diseases of lymphoid or reticuloendothelial tissue causing lymphadenitis are as follows:

  • Lymphosarcoma
  • Reticulum cell sarcoma
  • Malignant histocytosis or histocytic lymphoma
  • Nonendemic Burkitt tumor
  • Nasopharyngeal rhabdomyosarcoma
  • Thyroid carcinoma, chronic lymphocytic thyroiditis
  • Histiocytosis X
  • Kikuchi disease
  • Benign sinus histiocytosis
  • Angioimmunoblastic or immunoblastic lymphadenopathy
  • Chronic pseudolymphomatous lymphadenopathy (chronic benign lymphadenopathy)

Immunodeficiency syndromes and phagocytic dysfunction causing lymphadenitis are as follows:

Metabolic and storage diseases causing lymphadenitis are as follows:

Hematopoietic diseases causing lymphadenitis are as follows:

Miscellaneous disorders causing lymphadenitis are as follows:

  • PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) syndrome
  • Castleman disease (also known as benign giant lymph node hyperplasia)

Medications causing lymphadenitis are as follows:

  • Mesantoin – most commonly causes cervical lymphadenitis
  • Hydantoin - Generalized lymphadenopathy
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Contributor Information and Disclosures
Author

Elizabeth Partridge, MD, MPH Resident Physician, Department of Pediatrics, University of California Davis Children’s Hospital

Elizabeth Partridge, MD, MPH is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dean A Blumberg, MD Associate Professor of Pediatrics and Chief, Section of Pediatric Infectious Disease, University of California Davis Children's Hospital

Dean A Blumberg, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, California Medical Association, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Sierra Sacramento Valley Medical Society

Disclosure: Received grant/research funds from Novartis for clinical research investigator; Received speaking fees paid to university, not self from Merck for speaking and teaching; Received speaking fees paid to university, not self from sanofi pasteur for speaking and teaching.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Ulfat Shaikh, MD, MPH, to the development and writing of this article.

References
  1. Boldt DH. Lymphadenopathy and Splenomegaly, Internal Medicine, Stein. 5th Ed. 1998. Chapter 81.

  2. Pasternack MS, Marton NS. Lymphadenitis and Lymphangitis, Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. 2010. Chapter 92.

  3. Carvalho AC, Codecasa L, Pinsi G, Ferrarese M, Fornabaio C, Bergamaschi V. Differential diagnosis of cervical mycobacterial lymphadenitis in children. Pediatr Infect Dis J. 2010 Jul. 29(7):629-33. [Medline].

  4. Friedmann AM. Evaluation and management of lymphadenopathy in children. Pediatr Rev. 2008 Feb. 29(2):53-60. [Medline].

  5. Peters TR, Edwards KM. Cervical lymphadenopathy and adenitis. Pediatr Rev. 2000 Dec. 21(12):399-405. [Medline].

  6. Sejben I, Rácz A, Svébis M, Patyi M, Cserni G. Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia. Can Urol Assoc J. 2012 Aug. 6(4):E137-9. [Medline]. [Full Text].

  7. Raoot A, Dev G. Assessment of Status of rpoB Gene in FNAC Samples of Tuberculous Lymphadenitis by Real-Time PCR. Tuberc Res Treat. 2012. 2012:834836. [Medline]. [Full Text].

  8. Leung AK, Davies HD. Cervical lymphadenitis: etiology, diagnosis, and management. Curr Infect Dis Rep. 2009 May. 11(3):183-9. [Medline].

  9. Geake J, Hammerschlag G, Nguyen P, Wallbridge P, Jenkin GA, Korman TM, et al. Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. J Thorac Dis. 2015 Mar. 7(3):439-48. [Medline]. [Full Text].

  10. Dulin MF, Kennard TP, Leach L, Williams R. Management of cervical lymphadenitis in children. Am Fam Physician. 2008 Nov 1. 78(9):1097-8. [Medline].

  11. Guss J, Kazahaya K. Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. Int J Pediatr Otorhinolaryngol. 2007 Jun. 71(6):943-8. [Medline].

 
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A lymph node biopsy is performed. Note that a marking pen has been used to outline the node before removal and that a silk suture has been used to provide traction to assist the removal.
 
 
 
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