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11/27/2017 Lymphadenopathy - Cardiovascular Disorders - Merck Manuals Professional Edition

MERCK MANUAL

Professional Version
Some Causes of Lymphadenopathy

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Cause Suggestive Findings Diagnostic Approach
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Cause Suggestive Findings Diagnostic Approach uals.
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Infections ssion
al/car
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scula
Infections r-diso
rders
/lymp
Cervical adenopathy with only little or no hatic-
tenderness disor
URI Clinical evaluation
ders/l
Sore throat, runny nose, cough ymph
aden
opath
Cervical adenopathy only (often tender) y
Oropharyngeal infection (eg, pharyngitis, stomatitis, dental Clinical evaluation
abscess) Clinically apparent oropharyngeal infection

Symmetric adenopathy, typically cervical but


sometimes in axillae and/or inguinal areas
Heterophile antibody test
Fever, sore throat, severe fatigue
Mononucleosis Sometimes Epstein-Barr
Often splenomegaly virus serologic test
Typically in adolescents or young adults

Tuberculin skin testing or


Usually cervical or supraclavicular adenopathy, interferon-gamma release
TB (extrapulmonary TB—tuberculous lymphadenitis) sometimes inflamed or draining assay
Often in patients with HIV infection Usually node aspiration or
biopsy

Generalized adenopathy HIV antibody testing

HIV infection (primary infection) Usually fever, malaise, rash, arthralgia Sometimes HIV-RNA assay
(if early primary infection is
Often history of HIV exposure or high-risk activity suspected)

Except for secondary syphilis, only inguinal


adenopathy (fluctuant or draining nodes suggest
lymphogranuloma venereum) For herpes simplex, culture
Often urinary symptoms, urethral or cervical
For chlamydial infections,
Sexually transmitted diseases (STDs—particularly herpes simplex, discharge
nucleic acid-based testing
chlamydial infections, and syphilis)
Sometimes genital lesions
For syphilis, serologic
For secondary syphilis, often widespread testing
mucocutaneous lesions, generalized
lymphadenopathy

Usually a visible local lesion (or recent history of a


lesion) distal to site of adenopathy Usually clinical evaluation
Skin and soft-tissue infections (eg, cellulitis, abscess, cat-scratch
disease), including direct lymph node infection Sometimes only erythema, tenderness of an For cat scratch disease,
isolated node (often cervical) without apparent serum antibody titers
primary site of entry
11/27/2017 Lymphadenopathy - Cardiovascular Disorders - Merck Manuals Professional Edition

Cause Suggestive Findings Diagnostic Approach


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Bilateral, nontender cervical or axillary adenopathy www.

Sometimes a flu-like syndrome, merc


Toxoplasmosis Serologic testing
hepatosplenomegaly kman
Often history of exposure to cat feces uals.
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Vary profe
Other infections (eg, brucellosis, cytomegalovirus infection,
histoplasmosis, paracoccidioidomycosis, plague, rat bite fever, Varies ssion
Often risk factors (eg, geographic location,
tularemia) exposure) al/car
diova
Cancers scula
r-diso
Fatigue, fever, weight loss, splenomegaly rders
Leukemias (typically chronic and sometimes acute lymphocytic CBC, peripheral smear,
flow cytometry, bone /lymp
leukemia) With acute leukemia, often easy bruising and/or
bleeding marrow examination hatic-
disor
Painless adenopathy (local or generalized), often ders/l
rubbery, sometimes matted Lymph node biopsy or flow ymph
Lymphomas
Often fever, night sweats, weight loss, cytometry aden
splenomegaly
opath
y
One or several painless local nodes
Usually evaluation to
Metastatic cancers (often head and neck, thyroid, breast, or lung)
Nodes often hard, sometimes fixed to adjacent identify the primary tumor
tissue

Connective tissue disorders

Generalized adenopathy
Clinical criteria, antibody
Systemic lupus erythematosus (SLE) Typically arthritis or arthralgias
testing
Sometimes malar rash, other skin lesions

Chest imaging (plain x-ray


Painless adenopathy (local or generalized)
or CT)
Sarcoidosis Often cough and/or dyspnea, fever, malaise,
If imaging results are
muscle weakness, weight loss, joint pains
positive, node biopsy

Tender cervical adenopathy in children

Kawasaki disease Fever (usually > 39° C), truncal rash, strawberry Clinical criteria
tongue, periungual, palmar and plantar
desquamation

Other connective tissue disorders (eg, juvenile idiopathic arthritis,


Vary Varies
Kikuchi lymphadenopathy, RA, Sjögren syndrome)

Other conditions

History of using a causative drug


Drugs such as allopurinol, antibiotics (eg, cephalosporins,
penicillin, sulfonamides), atenolol, captopril, carbamazepine, Except for phenytoin, a serum sickness-type Clinical evaluation
phenytoin, pyrimethamine, and quinidine reaction (eg, rash, arthritis and/or arthralgias,
myalgia, fever)

Localized adenopathy in patients with breast Exclusion of other causes of


Silicone breast implants
implants adenopathy

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