Medical Care
In patients with lymphadenitis, treatment depends on the causative agent and may include expectant management, antimicrobial therapy, excision or chemotherapy and radiation (for malignancy). [11]
Expectant management is used when lymph nodes are smaller than 3 cm, without overlying erythema, not exquisitely tender, and present for 2 weeks or less.
A study by Haimi-Cohen et al indicated that an observation-only management strategy can be effective in cases of craniofacial nontuberculous mycobacterial lymphadenitis. The study, of 21 children with the condition, found that 18 patients demonstrated scar formation (26 scars total) at median 6.8-year follow-up, with 21 scars being 3 cm long or less, 20 having normal vascularity, 18 having normal pigmentation, and 21 having a normal to mildly uneven surface. Ninety-four percent of patients’ parents were content overall with the observation-only approach as a management alternative. [12]
Antimicrobial therapy is used when nodes are greater than 2-3 cm, are unilateral, have overlying erythema, and are tender. Antibiotics should target common infectious causes of lymphadenopathy, including S aureus and GAS. Owing to the increasing prevalence of community-acquired methicillin-resistant S aureus (MRSA), empiric therapy with clindamycin should be considered. [13] Trimethoprim-sulfamethoxazole is often effective for MRSA infection, but it is not appropriate for GAS infections.
Chemotherapy and radiotherapy are used for treatment of malignancies.
For details on medical therapy, please refer to the Medscape Reference article that discusses the specific diagnosed condition, including the following:
Consultations
Depending on the suspected etiology, consultations with the following specialists may be appropriate:
-
Infectious diseases specialist
-
Hematologist/oncologist
-
Dermatologist
-
Otolaryngologist
-
Surgeon
-
Interventional radiologist
-
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.
