Lymphadenopathy

Lymphadenopathy is commonly referred to as enlarged lymph nodes. This is part of the body’s immune response to any type of foreign invader.                            

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—-

• Breast cancer
• Bubonic plague
• Cat scratch disease
• Chronic infection
• Cytomegalovirus
• Dengue
• Drugs—

1. Carbamazepine
2. Allopurinol
3. Iran dextran
4. Meprobamate
5. PAS
6. Phenylbutazone
7. Primidone
8. Sulphadimidine
9. troxidone

• Epstein-Barr virus
• Erythroderma
• Follicular lymphomas
• Gaucher’s and Niemann-Pick disease
• Hairy cell leukemia
• 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
• Tumors
• Tumor metastasis
• Typhus fever
• Viral infection
• Virchow’s node
• Whipple’s disease

Symptoms And Signs—

General

• Swollen lymph nodes-
  Common areas for enlarged nodes are neck, inguinal, back of the head.
• Tender lymph nodes
• Warm, red skin(above the nodes)
• Fever

Specific

• Tuberculosis

1. Usually children
2. Adenopathy local cervical or general
3. Sudden increase in size of nodes
4. Painful nodes
5. Glands matted together
6. Caseous ,tender glands
7. No spleenomegaly
8. Tuberculosis elsewhere in the body

• Infectious mononucleosis

1. Adenitis mostly cervical

1. Glands discrete,moderately enlarged,slightly tender
2. Splenomegaly
3. Acute onset
4. Chills and sore throat

• Syphilis

1. Slight enlargement of posterior cervical and epitrochlear glands
2. Hard,painless,discrete glands
3. Skin rash
4. Mucous patches
5. Joint pain

• Lymphogranuloma inguinale

1. Initial lesion on genitalia small and herpetiform
2. Headache
3. Joint pain
4. Conjunctivitis
5. Rashes
6. Inguinal bubo
7. Suppuration of cervical glands in primary lesion of mouth(rare)

• Systemic lupus erythematous

1. Acute onset
2. Generalized lymphadenopathy
3. Recurrent septic type fever
4. Flushed face
5. Erythematous lesions on trunk and extremities
6. Ulcer and erosion of mouth
7. Splenomegaly
8. Arthritic pain
9. Cardiac manifestations
10. Purpura

• HIV 

1. Sudden onset of fever
2. Myalgia
3. Arthralgia
4. Sore throat
5. Diarrhoea
6. Transient erythematous macular rash on trunk

• Acute viral hepatitis 

1. Jaundice
2. Hepatic tenderness
3. Hepatomegaly

• Rubella 

1. Suboccipital ,postauricular and posterior cervical lymphadenopathy
2. Typical rash

• Fungal infections

1. Coccidioidomycosis (Infection of skin, bones, joints, spleen, liver, kidneys, meningitis, brain)
2. Histoplasmosis
3. Hepatomegaly
4. Splenomegaly
5. Oral/GI ulceration

• Serum sickness

1. Cutaneous eruptions
2. Arthralgias

• Tularemia

1. Local lesion
2. Chills and headache
3. Body aches
4. Enlargement of regional lymph node ,may progress to chronic indolent abscess

• Acute lymphoblastic leukemia       

1. Discrete non-tender glands
2. Haemorrhages
3. Stomatitis
4. Bone pains

• Chronic lymphocytic leukemia 

1. Large discrete glands
2. Irregular fever
3. Haemorrhages
4. Skin eruptions

• Hodgkin’s disease

1. Painless and discrete glands
2. Mostly cervical; may be axillary, inguinal, abdominal or mediastinal
3. Gland appears like a pyramidal swelling with base at clavicle and apex at angle of jaw
4. Pressure symptoms
5. Generalized pruritis
6. Splenomegaly

• Non-Hodgkin’s lymphomas

1. Painless adenopathy in cervical,axillary and inguinofemoral areas
2. Hypersplenism
3. Rapidly progressing nodal disease with bone marrow involvement
4. Extra-lymphatic involvement(GI tract, thyroid, testes, bones)

• Follicular lymphomas

Benign initial phase is followed by malignant phase

• Sarcoidosis

1. Involvement of pre- and post-auricular,sub
2. maxillary,epitrochlear and paratracheal glands
3. Sarcoid lesions of skin,uveitis or parotitis

• Toxoplasmosis 

1. Painless enlargement of cervical lymph nodes
2. Mobile,discrete glands

• Secondary carcinoma

Glands-painless, hard, non-tender, fixed, localized

• Mucocutaneous lymph node syndrome (Kawasaki)

1. Usually in infants and children below 5 yrs age
2. Exanthem
3. Bilateral conjunctivitis
4. Polyarteritis

• Sinus histiocytosis

1. Generalized glandular enlargement
2. Massive cervical lymphadenopathy

• Angio-immunoblastic lymphadenopathy

1. Hepatosplenomegaly
2. Fever
3. Autoimmune hemolytic anaemia
4. Hypergammaglobulinemia

• Multi focal Langerhans cell granulomatosis

1. Multiple bony lesions
2. Diabetes insipidus
3. 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.