Lymphadenitis Clinical Presentation

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

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 Causes section 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

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, 14]}

• 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:

• Juvenile rheumatoid arthritis

• Graft versus host disease

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

• Acute lymphoblastic leukemia

• Lymphosarcoma

• Reticulum cell sarcoma

• Non-Hodgkin lymphoma

• Malignant histocytosis or histocytic lymphoma

• Nonendemic Burkitt tumor

• Nasopharyngeal rhabdomyosarcoma

• Neuroblastoma

• 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:

• Chronic granulomatous disease of childhood

• Acquired immunodeficiency syndrome

• Hyperimmunoglobulin E (Job) syndrome

Metabolic and storage diseases causing lymphadenitis are as follows:

• Gaucher disease

• Niemann-Pick disease

• Cystinosis

Hematopoietic diseases causing lymphadenitis are as follows:

• Sickle cell anemia

• Thalassemia

• Congenital hemolytic anemia

• Autoimmune hemolytic anemia

Miscellaneous disorders causing lymphadenitis are as follows:

• Kawasaki disease

• PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) syndrome

• Sarcoidosis

• 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