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ULY CLINIC

12 Septemba 2025, 00:04:48

Lymphadenopathy

Lymphadenopathy is the enlargement of one or more lymph nodes, resulting from increased production of lymphocytes or reticuloendothelial cells, or infiltration by abnormal cells. It can be localized (affecting a specific node group) or generalized (involving three or more node groups). Generalized lymphadenopathy often reflects systemic conditions such as infections, autoimmune disorders, endocrine dysfunction, or malignancies, whereas localized lymphadenopathy usually arises from infection or trauma in the drainage area. Prompt assessment is essential to differentiate benign from serious causes and to guide management.

History and Physical Examination

Determine onset, duration, location, and symmetry of lymph node enlargement.
Assess tenderness, mobility, consistency, erythema, or matted texture.
Ask about recent infections, trauma, immunizations, family history of cancer, and prior biopsies.
Palpate all lymph node regions systematically: cervical, axillary, epitrochlear, inguinal, and supraclavicular.
Examine draining areas for infection.
Percuss and palpate the spleen to assess for hepatosplenomegaly.

Normal nodes: discrete, mobile, soft, non-tender, and usually <1 cm in adults.

Causes of Lymphadenopathy

Cause	Onset / Pattern	Pain / Symptom Characteristics	Distinguishing Features / Associated Findings	Emergency / Urgent Concern
Acquired Immunodeficiency Syndrome (AIDS)	Gradual	Generalized lymphadenopathy	Fatigue, night sweats, fevers, diarrhea, weight loss, recurrent infections	Opportunistic infections; immune support needed
Anthrax (cutaneous)	Rapid	Regional lymph node swelling	Necrotic-centered painless ulcer, malaise, headache, fever	Immediate antibiotic therapy required
Brucellosis	Gradual or abrupt	Tender lymph nodes (cervical/axillary)	Fever with morning rise, diaphoresis, malaise, backache, arthralgia	Treat with appropriate antibiotics; monitor for chronic disease
Cytomegalovirus (CMV) infection	Gradual	Generalized lymphadenopathy	Fever, malaise, rash, hepatosplenomegaly, especially in immunocompromised	Supportive care; monitor immune status
Hodgkin’s disease	Gradual	Painless or mildly tender nodes	Stage-dependent; pruritus, fatigue, night sweats, weight loss; mediastinal pressure may cause dyspnea/dysphagia	Oncologic referral; chemotherapy/radiation
Kawasaki disease	Acute	Cervical lymphadenopathy	Fever ≥5 days, rash, conjunctivitis, strawberry tongue, extremity edema, cardiovascular risk	IVIG and aspirin therapy urgently
Leptospirosis	Rare	Mild lymphadenopathy	Fever, chills, myalgia, headache, nausea, vomiting, abdominal pain	Supportive care; antibiotics if severe
Leukemia (acute lymphocytic)	Gradual	Generalized	Fatigue, pallor, low-grade fever, bleeding, hepatosplenomegaly, bone/joint pain	Hematologic emergency; chemotherapy
Leukemia (chronic lymphocytic)	Gradual	Early generalized lymphadenopathy	Fatigue, hepatosplenomegaly, anemia, edema, palpitations, bone tenderness	Hematology referral; monitor disease progression
Lyme disease	Gradual	Localized or generalized	Erythema migrans, malaise, intermittent fever, arthralgia, neurologic or cardiac signs	Antibiotic therapy; monitor for systemic involvement
Monkeypox	Gradual	Lymph node swelling 12 days post-infection	Fever, conjunctivitis, cough, rash, myalgia, fatigue	Symptomatic treatment; isolation recommended
Mononucleosis (infectious)	Gradual	Painful cervical, axillary, inguinal lymphadenopathy	Sore throat, fever, malaise, hepatosplenomegaly, exudative tonsillitis	Supportive care; avoid contact sports
Mycosis fungoides	Late-stage	Lymphadenopathy	Stage III disease: ulcerated, itchy, painful skin tumors	Dermatology/oncology referral
Non-Hodgkin’s lymphoma	Gradual	Painless peripheral nodes	Dyspnea, hepatosplenomegaly, systemic B-symptoms	Oncologic evaluation
Plague (Yersinia pestis)	Rapid	Regional tender nodes (buboes)	Fever, chills, malaise	Immediate antibiotics; isolation
Rheumatoid arthritis	Gradual	Mild lymphadenopathy	Early fatigue, low-grade fever, arthralgia; later joint deformities	Disease-modifying treatment needed
Sarcoidosis	Gradual	Generalized lymphadenopathy	Bilateral hilar/mediastinal lymphadenopathy, splenomegaly, pulmonary symptoms, skin/musculoskeletal involvement	Monitor organ involvement; systemic therapy if needed
Sjögren’s syndrome	Gradual	Parotid/submaxillary nodes	Dry mouth, eyes, mucosa, photosensitivity, epistaxis	Symptomatic care; monitor autoimmune progression
Secondary Syphilis	Gradual	Generalized lymphadenopathy	Palmar/plantar rash, malaise, sore throat, low-grade fever	Antibiotic therapy required
Systemic Lupus Erythematosus (SLE)	Gradual	Generalized	Butterfly rash, photosensitivity, arthralgia, pleuritic pain	Immunosuppressive therapy; monitor organ involvement
Tuberculous lymphadenitis	Gradual	Fluctuant nodes	Draining sinuses, fever, chills, fatigue	Anti-TB therapy; infection control
Waldenström’s macroglobulinemia	Gradual	Generalized	Hepatosplenomegaly, retinal hemorrhage, heart failure signs, neuropathy	Hematology referral; manage hyperviscosity
Drug-induced	Variable	Generalized	Phenytoin commonly implicated	Discontinue offending drug; supportive care
Post-immunization	Temporary	Mild generalized	Typhoid vaccination may cause temporary swelling	Usually self-limiting

Special Considerations

Fever >101°F (38.3°C) may aid in infection control and recovery; antipyretics used only if the patient is uncomfortable.
Obtain routine labs: CBC, liver/renal function, ESR, blood cultures.
Prepare for imaging (chest X-ray, lymphography) and possible biopsy.
Observe infection control policies if infectious causes are suspected.

Patient Counseling

Educate on infection prevention and recognizing warning signs.
Explain isolation precautions if necessary.
Stress importance of rest, nutrition, and follow-up care.

Pediatric Pointers

Infection is the most common cause in children, often associated with otitis media or pharyngitis.
Administer antipyretics cautiously if febrile seizures are a history.
Monitor for rapid changes in lymph node size or systemic symptoms.

References

Kalungi S, Wabinga H, Bostad L. Reactive lymphadenopathy in Ugandan patients and its relationship to EBV and HIV infection. APMIS. 2009;117:302–307.
Ramos CG, Goldani LZ. Biopsy of peripheral lymph nodes: A useful tool to diagnose opportunistic diseases in HIV-infected patients. Tropical Doctor. 2011;41:26–27.