Lymphadenopathy is commonly referred to as enlarged lymph nodes. This is part of the body’s immune response to any type of foreign invader.
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Classification
- Localized lymphadenopathy — Limited to one area of involvement
- Generalized Lymphadenopathy — Two or more non-contiguous areas
- Dermatopathic lymphadenopathy — Associated with a case of skin disease.
Causes of Lymphadenopathy
- Breast cancer
- Bubonic plague
- Cat scratch disease
- Chronic infection
- Cytomegalovirus
- Dengue
- Drugs—
- Carbamazepine
- Allopurinol
- Iran dextran
- Meprobamate
- PAS
- Phenylbutazone
- Primidone
- Sulphadimidine
- troxidone
- Epstein-Barr virus
- Erythroderma
- Follicular lymphomas
- Gaucher’s and Niemann-Pick disease
- Hairy cell leukaemia
- Hepatitis A and B
- Herpes virus 2
- Histoplasmosis
- HIV/AIDS
- Hodgkin lymphoma
- Human African trypanosomiasis
- Infectious mononucleosis
- Leprosy
- Neuroblastoma
- Non-Hodgkin lymphoma
- Parasitic disease
- Radiotherapy
- Sarcoidosis
- Snake or spider bites
- Stomach cancer
- Syphilis
- Systemic lupus erythematosus
- Toxoplasmosis
- Tuberculous lymphadenitis
- Tumours
- Tumour metastasis
- Typhus fever
- Viral infection
- Virchow’s node
- Whipple’s disease
Symptoms and signs
General
- Swollen lymph nodes-
Common areas for enlarged nodes are the neck, inguinal, and back of the head. - Tender lymph nodes
- Warm, red skin(above the nodes)
- Fever
Tuberculosis
- Usually children
- Adenopathy local cervical or general
- A sudden increase in the size of nodes
- Painful nodes
- Glands matted together
- Caseous, tender glands
- No splenomegaly
- Tuberculosis elsewhere in the body
Infectious mononucleosis
- Adenitis mostly cervical
- Glands are discrete, moderately enlarged, slightly tender
- Splenomegaly
- Acute onset
- Chills and sore throat
Syphilis
- Slight enlargement of posterior cervical and epitrochlear glands
- Hard, painless, discrete glands
- Skin rash
- Mucous patches
- Joint pain
Lymphogranuloma inguinale
- Initial lesion on genitalia small and herpetiform
- Headache
- Joint pain
- Conjunctivitis
- Rashes
- Inguinal bubo
- Suppuration of cervical glands in the primary lesion of the mouth(rare)
Systemic lupus erythematous
- Acute onset
- Generalized lymphadenopathy
- Recurrent septic type fever
- Flushed face
- Erythematous lesions on trunk and extremities
- Ulcer and erosion of mouth
- Splenomegaly
- Arthritic pain
- Cardiac manifestations
- Purpura
HIV
- Sudden onset of fever
- Myalgia
- Arthralgia
- Sore throat
- Diarrhoea
- Transient erythematous macular rash on the trunk
- Jaundice
- Hepatic tenderness
- Hepatomegaly
Rubella
- Suboccipital, postauricular and posterior cervical lymphadenopathy
- Typical rash
Fungal infections
- Coccidioidomycosis (Infection of skin, bones, joints, spleen, liver, kidneys, meningitis, brain)
- Histoplasmosis
- Hepatomegaly
- Splenomegaly
- Oral/GI ulceration
Serum sickness
- Cutaneous eruptions
- Arthralgias
Tularemia
- Local lesion
- Chills and headache
- Body aches
- Enlargement of the regional lymph node may progress to chronic indolent abscess
Acute lymphoblastic leukaemia
- Discrete non-tender glands
- Haemorrhages
- Stomatitis
- Bone pains
Chronic lymphocytic leukaemia
- Large discrete glands
- Irregular fever
- Haemorrhages
- Skin eruptions
Hodgkin’s disease
- Painless and discrete glands
- Mostly cervical; may be axillary, inguinal, abdominal or mediastinal
- Gland appears like a pyramidal swelling with the base at the clavicle and apex at an angle of the jaw
- Pressure symptoms
- Generalized pruritis
- Splenomegaly
Non-Hodgkin’s lymphomas
- Painless adenopathy in cervical, axillary and inguinofemoral areas
- Hypersplenism
- Rapidly progressing nodal disease with bone marrow involvement
- Extra-lymphatic involvement(GI tract, thyroid, testes, bones)
Follicular lymphomas
The benign initial phase is followed by a malignant phase
Sarcoidosis
- Involvement of pre- and post-auricular, sub maxillary, epitrochlear and paratracheal glands
- Sarcoid lesions of skin,uveitis or parotitis
Toxoplasmosis
- Painless enlargement of cervical lymph nodes
- Mobile, discrete glands
Secondary carcinoma
Glands-painless, hard, non-tender, fixed, localized
Mucocutaneous lymph node syndrome (Kawasaki)
- Usually in infants and children below 5 yrs age
- Exanthem
- Bilateral conjunctivitis
- Polyarteritis
Sinus histiocytosis
- Generalized glandular enlargement
- Massive cervical lymphadenopathy
Angio-immunoblastic lymphadenopathy
- Hepatosplenomegaly
- Fever
- Autoimmune hemolytic anaemia
- Hypergammaglobulinemia
Multi-focal Langerhans cell granulomatosis
- Multiple bony lesions
- Diabetes insipidus
- Hepatosplenomegaly
Investigations
- Physical examinations (local and systemic)
- Lymph node biopsy
- VDRL (for syphilis)
- Monospot test (infectious mononucleosis)
- Frei test (lymphogranuloma)
- Liver biopsy (sarcoidosis)
- X-ray (lungs, GIT)
- CT-scan Abdomen (Lymphoma)
- Lymphangiography
Treatment
The treatment is cause-specific and mostly medicinal.