Chapter 484 Lymphadenopathy
Diagnosis
Is the lymphadenopathy localized or generalized? Generalized adenopathy (enlargement of >2 noncontiguous node regions) is caused by systemic disease (Table 484-1) and is often accompanied by abnormal physical findings in other systems. In contrast, regional adenopathy is most frequently the result of infection in the involved node and/or its drainage area (Table 484-2). When due to infectious agents other than bacteria, adenopathy may be characterized by atypical anatomic areas, a prolonged course, a draining sinus, lack of prior pyogenic infection, and unusual clues in the history (cat scratches, tuberculosis exposure, venereal disease). A firm, fixed node should always raise the question of malignancy, regardless of the presence or absence of systemic symptoms or other abnormal physical findings.
INFANT | CHILD | ADOLESCENT |
---|---|---|
COMMON CAUSES | ||
Syphilis | Viral infection | Viral infection |
Toxoplasmosis | EBV | EBV |
CMV | CMV | CMV |
HIV | HIV | HIV |
Toxoplasmosis | Toxoplasmosis | |
Syphilis | ||
RARE CAUSES | ||
Chagas disease (congenital) | Serum sickness | Serum sickness |
Congenital leukemia | SLE, JRA | SLE, JRA |
Congenital tuberculosis | Leukemia/lymphoma | Leukemia/lymphoma/Hodgkin disease |
Reticuloendotheliosis | Tuberculosis | Lymphoproliferative disease |
Lymphoproliferative disease | Measles | Tuberculosis |
Metabolic storage disease | Sarcoidosis | Histoplasmosis |
Histiocytic disorders | Fungal infection | Sarcoidosis |
Plague | Fungal infection | |
Langerhans cell histiocytosis | Plague | |
Chronic granulomatous disease | Drug reaction | |
Sinus histiocytosis | Castleman disease | |
Drug reaction |
CMV, cytomegalovirus; EBV, Epstein-Barr virus; HIV, human immunodeficiency virus; JRA, juvenile rheumatoid arthritis (Still disease); SLE, systemic lupus erythematosus.
From Kliegman RM, Greenbaum LA, Lye PS: Practical strategies in pediatric diagnosis and therapy, ed 2, Philadelphia, 2004, Elsevier, p 863.
Table 484-2 SITES OF LOCAL LYMPHADENOPATHY AND ASSOCIATED DISEASES
CERVICAL
ANTERIOR AURICULAR
SUPRACLAVICULAR
EPITROCHLEAR
INGUINAL