Some Causes of Lymphadenopathy
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Cancers | ||
Leukemias (typically chronic and sometimes acute lymphocytic leukemia) | Fatigue, fever, weight loss, splenomegaly With acute leukemia, often easy bruising and/or bleeding | Complete blood count, peripheral smear, flow cytometry, bone marrow examination |
Painless adenopathy (local or generalized), often rubbery, sometimes matted Often fever, night sweats, weight loss, splenomegaly | Lymph node biopsy and flow cytometry | |
Metastatic cancers (often head and neck, thyroid, breast, or lung) | One or several painless local nodes Nodes often hard, sometimes fixed to adjacent tissue | Usually evaluation to identify the primary tumor Biopsy if primary cancer not found |
Systemic and systemic rheumatic disorders | ||
Tender cervical adenopathy in children Fever (usually > 39° C), truncal rash, strawberry tongue, periungual, palmar and plantar desquamation | Clinical criteria | |
Painless adenopathy (local or generalized) Often cough and/or dyspnea, fever, malaise, muscle weakness, weight loss, joint pains | Chest imaging (plain x-ray or CT) If imaging results are positive, node biopsy | |
Generalized adenopathy Typically arthritis or arthralgias Sometimes malar rash, other skin lesions | Clinical criteria Antibody testing | |
Other systemic rheumatic disorders (eg, juvenile idiopathic arthritis, Kikuchi lymphadenopathy (necrotizing histiocytic lymphadenitis), rheumatoid arthritis, Sjögren syndrome) | Vary | Varies |
Infections | ||
HIV infection (primary infection) | Generalized adenopathy Usually fever, malaise, rash, arthralgia Often history of HIV exposure or high-risk activity | HIV antibody testing Sometimes HIV-RNA assay (if early primary infection is suspected) |
Symmetric adenopathy, typically cervical but sometimes in axillae and/or inguinal areas Fever, sore throat, severe fatigue Often splenomegaly Typically in adolescents or young adults | Heterophile antibody test Sometimes Epstein-Barr virus serologic testing | |
Oropharyngeal infection (eg, pharyngitis, stomatitis, dental abscess) | Cervical adenopathy only (often tender) Clinically apparent oropharyngeal infection | Clinical evaluation |
Sexually transmitted infections (STIs—particularly herpes simplex, chlamydial infections, and syphilis) | Except for secondary syphilis, only inguinal adenopathy (fluctuant or draining nodes suggest lymphogranuloma venereum) Often urinary symptoms, urethral or cervical discharge Sometimes genital lesions For secondary syphilis, often widespread mucocutaneous lesions, generalized lymphadenopathy | For herpes simplex, culture For chlamydial infections, nucleic acid-based testing For syphilis, serologic testing |
Skin and soft-tissue infections (eg, cellulitis, abscess, cat-scratch disease), including direct lymph node infection | Usually a visible local lesion (or recent history of a lesion) distal to site of adenopathy Sometimes only erythema, tenderness of an isolated node (often cervical) without apparent primary site of entry | Usually clinical evaluation For cat scratch disease, serum antibody titers |
Bilateral, nontender cervical or axillary adenopathy Sometimes a flu-like syndrome, hepatosplenomegaly Often history of exposure to cat feces | Serologic testing | |
Tuberculosis (extrapulmonary tuberculosis—tuberculous lymphadenitis) | Usually cervical or supraclavicular adenopathy, sometimes inflamed or draining Often in patients with HIV infection | Tuberculin skin testing or interferon-gamma release assay Usually node aspiration or biopsy |
Upper respiratory infection | Cervical adenopathy with only little or no tenderness Sore throat, runny nose, cough | Clinical evaluation |
Other infections (eg, brucellosis, cytomegalovirus infection, histoplasmosis, paracoccidioidomycosis, plague, rat-bite fever, tularemia) | Vary Often risk factors (eg, geographic location, exposure) | Varies |
Other conditions | ||
History of using a causative medication Except for phenytoin, a serum sickness-type reaction (eg, rash, arthritis and/or arthralgias, myalgia, fever) | Clinical evaluation | |
Silicone breast implants | Localized adenopathy in patients with breast implants | Exclusion of other causes of adenopathy |
CT = computed tomography; HIV = human immunodeficiency virus. | ||