Lymphadenitis is an acute infection of one or more lymph nodes. Symptoms include pain, tenderness, and lymph node enlargement. Diagnosis is typically clinical. Treatment is usually empiric.
(See also Overview of Bacterial Skin Infections and Lymphangitis.)
Lymphadenitis is a feature of many bacterial, viral, fungal, and protozoal infections.
Focal lymphadenitis is prominent in the following:
Multifocal lymphadenitis may occur in patients with the following:
Symptoms and Signs of Lymphadenitis
Lymphadenitis typically causes pain, tenderness, and lymph node enlargement. Pain and tenderness typically distinguish lymphadenitis from lymphadenopathy. With some infections, the overlying skin is inflamed, occasionally with cellulitis. Abscesses may form, and penetration to the skin produces draining sinuses. Fever is common.
Diagnosis of Lymphadenitis
Clinical evaluation
Sometimes aspiration and culture or excisional biopsy
The underlying disorder is usually suggested by history and examination. Enlarged lymph nodes that do not cause pain, tenderness, or erythema may raise concern for other disorders such as lymphomas.
If not, aspiration and culture or excisional biopsy is indicated (1).
Diagnosis reference
1. Olivas-Mazón R, Blázquez-Gamero D, Alberti-Masgrau N, et al: Diagnosis of nontuberculous mycobacterial lymphadenitis: The role of fine-needle aspiration. Eur J Pediatr 180(4):1279–1286, 2021. doi: 10.1007/s00431-020-03875-2
Treatment of Lymphadenitis
Treatment of cause
Treatment of lymphadenitis is directed at the cause and is usually empiric.
Empiric options include IV antibiotics, typically directed at Staphylococcus aureus and Streptococcus pyogenes or atypical mycobacterial infections; antifungals; and antiparasitics depending on etiology or clinical suspicion. Many patients with lymphadenitis may respond to outpatient therapy with oral antibiotics. However, many patients also go on to form abscesses, which require surgical drainage; an extensive procedure is done with accompanying IV antibiotics. In children, IV antibiotics are commonly needed.
Hot, wet compresses may relieve some pain.
Lymphadenitis usually resolves with timely treatment, although residual, persistent, nontender lymphadenopathy is common.
