Lymphadenitis

Increased lymph node size may be caused by the following:

• Multiplication of cells within the node, including lymphocytes, plasma cells, monocytes, or histiocytes

• Infiltration of cells from outside the node, such as malignant cells or neutrophils

• Draining of an infection (eg, abscess) into local lymph nodes

Infectious agents/causes and lymphadenitis characteristics are as follows ^[2] :

• Bartonella henselae (catscratch disease) – Single-node involvement determined by scratch site; discrete, mobile, nontender

• Coccidioides immitis (coccidioidomycosis) – Mediastinal

• Cytomegalovirus – Generalized

• Dental caries/abscess – Submaxillary

• Epstein-Barr virus (mononucleosis) - Anterior cervical, mediastinal, bilateral; discrete, firm, nontender

• Francisella tularensis (tularemia) - Cervical, mediastinal, or generalized; tender

• Histoplasma capsulatum (histoplasmosis) – Mediastinal

• Atypical Mycobacterium - Cervical, submandibular, submental (usually unilateral); most commonly in immunocompetent children aged 1-5 years ^{[3, 4]}

• Mycobacterium tuberculosis - Mediastinal, mesenteric, anterior cervical, localized disease (discrete, firm, mobile, tender); generalized hematogenous spread (soft, fluctuant, matted, and adhere to overlying, erythematous skin)

• Parvovirus - Posterior auricular, posterior cervical, occipital

• Rubella - Posterior auricular, posterior cervical, occipital

• Salmonella - Generalized

• Seborrheic dermatitis, scalp infections - Occipital, postauricular

• Staphylococcus aureus adenitis - Cervical, submandibular; unilateral, firm, tender

• Group A streptococcal (GAS) pharyngitis - Submandibular and anterior cervical; unilateral, firm, tender

• Toxoplasma gondii - Generalized, often nontender

• Viral pharyngitis - Bilateral postcervical; firm, tender

• Yersinia enterocolitica - Cervical or abdominal

• Yersinia pestis (plague) - Axillary, inguinal, femoral, cervical; extremely tender with overlying erythema

Immunologic or connective tissue disorders causing lymphadenitis are as follows:

• Juvenile rheumatoid arthritis

• Graft versus host disease

Primary diseases of lymphoid or reticuloendothelial tissue causing lymphadenitis are as follows:

• Acute lymphoblastic leukemia

• Lymphosarcoma

• Reticulum cell sarcoma

• Non-Hodgkin lymphoma

• Malignant histocytosis or histocytic lymphoma

• Nonendemic Burkitt tumor

• Nasopharyngeal rhabdomyosarcoma

• Neuroblastoma

• Thyroid carcinoma, chronic lymphocytic thyroiditis

• Histiocytosis X

• Kikuchi disease

• Benign sinus histiocytosis

• Angioimmunoblastic or immunoblastic lymphadenopathy

• Chronic pseudolymphomatous lymphadenopathy (chronic benign lymphadenopathy)

Immunodeficiency syndromes and phagocytic dysfunction causing lymphadenitis are as follows:

• Chronic granulomatous disease of childhood

• Acquired immunodeficiency syndrome

• Hyperimmunoglobulin E (Job) syndrome

Metabolic and storage diseases causing lymphadenitis are as follows:

• Gaucher disease

• Niemann-Pick disease

• Cystinosis

Hematopoietic diseases causing lymphadenitis are as follows:

• Sickle cell anemia

• Thalassemia

• Congenital hemolytic anemia

• Autoimmune hemolytic anemia

Miscellaneous disorders causing lymphadenitis are as follows:

• Kawasaki disease

• PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) syndrome

• Sarcoidosis

• Castleman disease (also known as benign giant lymph node hyperplasia)

Medications causing lymphadenitis are as follows:

• Mesantoin - Most commonly causes cervical lymphadenitis

• Hydantoin - Generalized lymphadenopathy

Prognosis depends on the etiology of the lymphadenopathy and timing of intervention.

Complications

The following complications may occur:

• Cellulitis

• Suppuration

• Systemic involvement

• Internal jugular vein thrombosis

• Septic embolic phenomena

• Carotid artery rupture

• Mediastinal abscess

• Purulent pericarditis