Lymphadenopathy

• Viral infections: Commonly seen with Epstein-Barr virus (EBV), cytomegalovirus (CMV), and HIV; typically presents with generalized lymphadenopathy and systemic symptoms like fever and malaise.
• Bacterial infections: Includes streptococcal and staphylococcal infections, which often cause localized lymphadenopathy with tenderness and erythema.
• Tuberculosis: Causes chronic, often painless lymphadenopathy, usually in the cervical region; nodes may become matted or form abscesses.
• Sexually transmitted infections (STIs): Lymphogranuloma venereum and syphilis can cause inguinal lymphadenopathy, often associated with genital ulcers.

• Lymphoma: Hodgkin’s and non-Hodgkin’s lymphomas present with painless, rubbery lymph nodes; often accompanied by systemic symptoms like night sweats, fever, and weight loss.
• Leukemia: Acute and chronic leukemias can cause generalized lymphadenopathy, often with splenomegaly, anemia, and bleeding tendencies.
• Metastatic cancer: Lymphadenopathy due to spread of malignancy from primary sites such as breast, lung, or gastrointestinal tract; nodes are typically hard, fixed, and non-tender.
• Kaposi’s sarcoma: Often associated with HIV/AIDS; presents with purple, vascular skin lesions and associated lymphadenopathy.

• Systemic lupus erythematosus (SLE): Causes generalized lymphadenopathy, often with arthralgia, skin rashes, and renal involvement.
• Rheumatoid arthritis: Can cause localized or generalized lymphadenopathy, usually associated with joint pain, stiffness, and other systemic features.
• Sarcoidosis: Granulomatous disease causing bilateral hilar lymphadenopathy, often with pulmonary symptoms and hypercalcemia.

• Drug-induced lymphadenopathy: Certain medications, such as phenytoin and allopurinol, can cause lymph node enlargement as a side effect.
• Kikuchi-Fujimoto disease: A rare, benign condition causing cervical lymphadenopathy, typically in young women; associated with fever and night sweats.
• Castleman disease: A rare lymphoproliferative disorder causing localized or generalized lymphadenopathy, often associated with systemic symptoms.

Acute onset may suggest an infectious cause, while chronic, progressive lymphadenopathy may be more indicative of malignancy or autoimmune disease.

• Fever, night sweats, and weight loss: Often referred to as ‘B symptoms’, these suggest lymphoma or other malignancies.
• Sore throat, cough, or upper respiratory symptoms: Suggest a viral or bacterial infection, such as EBV or streptococcal pharyngitis.
• Joint pain and rash: Can be indicative of autoimmune conditions like SLE or rheumatoid arthritis.
• Fatigue and pallor: May suggest underlying leukemia or other hematological malignancies.
• Skin lesions or ulcers: Suggestive of Kaposi’s sarcoma, syphilis, or tuberculosis.

• Past medical history: Important to identify any history of infections, autoimmune conditions, or malignancies.
• Drug history: Consider recent medications that could cause lymphadenopathy, such as phenytoin or certain antibiotics.
• Family history: Look for a family history of lymphoproliferative disorders, autoimmune diseases, or inherited conditions.
• Social history: Includes travel history (relevant for infections like tuberculosis), sexual history (for STIs), and occupational exposures.

• Full blood count: To assess for anemia, leukocytosis, or lymphocytosis, which may indicate leukemia or infection.
• Liver function tests: Can be abnormal in systemic infections, lymphoma, or metastatic disease.
• Serology: For specific infections like EBV, CMV, HIV, syphilis, or tuberculosis, depending on the clinical context.
• Autoimmune screen: Includes antinuclear antibodies (ANA) and rheumatoid factor (RF) to assess for autoimmune conditions like SLE or rheumatoid arthritis.
• Lactate dehydrogenase (LDH): Often elevated in lymphoma and some leukemias.
• Peripheral blood smear: To identify any abnormal cells suggestive of leukemia or lymphoma.

• Chest X-ray: To assess for mediastinal lymphadenopathy, which can be seen in lymphoma, sarcoidosis, or tuberculosis.
• Ultrasound: Useful for evaluating the size, shape, and consistency of superficial lymph nodes, particularly in the neck, axilla, or groin.
• CT or MRI scan: Provides detailed imaging of deep lymph nodes, often used in the staging of lymphoma or detection of metastatic disease.
• PET scan: Helpful in assessing metabolic activity of lymph nodes, particularly in lymphoma and metastatic disease.

• Lymph node biopsy: Excisional or core biopsy is often required for definitive diagnosis, particularly in cases of suspected lymphoma or metastatic cancer.
• Bone marrow biopsy: Indicated if leukemia, lymphoma, or other bone marrow-infiltrative processes are suspected.
• Flow cytometry: Performed on blood, bone marrow, or lymph node samples to diagnose specific types of leukemia or lymphoma.
• Mantoux test: Used to screen for tuberculosis in patients with unexplained lymphadenopathy, especially if there is a history of exposure.