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


Professional Version
Some Causes of Lymphadenopathy

Cause Suggestive Findings Diagnostic Approach
Cause Suggestive Findings Diagnostic Approach uals.
Infections ssion
Infections r-diso
Cervical adenopathy with only little or no hatic-
tenderness disor
URI Clinical evaluation
Sore throat, runny nose, cough ymph
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

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

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

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.
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
Cancers scula
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-
Painless adenopathy (local or generalized), often ders/l
rubbery, sometimes matted Lymph node biopsy or flow ymph
Often fever, night sweats, weight loss, cytometry aden
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

Connective tissue disorders

Generalized adenopathy
Clinical criteria, antibody
Systemic lupus erythematosus (SLE) Typically arthritis or arthralgias
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

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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