LYMPHADENOPATHY

Remember-

Generally, lymph nodes less than 3 mm are considered normal

Abnormal lymph nodes are as below

• Epitrochlear lymph nodes > 5mm

• Cervical lymph nodes >10 mm

• Inguinal lymph nodes > 15 mm

TYPES

• a) Generalised lymphadenopathy-

When 2 or more groups of lymph node regions are enlarged

Liver and spleen may also be enlarged.

• b) Local lymphadenopathy

CAUSES

a) Systemic infections

• Bacterial infections

• Viral infections- EBV/ EMV/ Hepatitis/

• Tuberculosis/ syphilis/ Toxoplasma

• Brucella/ typhoid/ malaria

• Chronic granulomatous disease/ HIV

b) Immune-mediated conditions

• SLE/ Rheumatoid arthritis

• Kawasaki disease/ Hyper IgD syndrome

c) Storage diseases-

• Gaucher/ Niemann Pick disease

d) Malignancy-

• Leukemia/ Lymphoma

• Neuroblastoma/ Histiocytosis

e) Metabolic causes-

• Hyperthyroidism/ adrenal insufficiency

• Sarcoidosis/ Histiocytosis

CERVICAL LYMPHADENOPATHY CAUSES-

• Viral Upper respiratory tract infection( EBV/CMV virus)

• Bacterial infection (Staphylococcal/ Streptococcal)

• Atypical mycobacterial adenitis

• Toxoplasmosis

• Kawasaki disease

• Hyper IgD or IgE syndrome

• Histiocytosis

• Sarcoidosis

HISTORY to consider-

• History of fever- Suggesting systemic infections

• History of rash- Suggesting EBV/ CMV/ Chronic granulomatous disease/ syphilis

• History of travel- look for Malaria/ Histoplasmosis

• History of animal exposure- suggesting Brucellosis/ cat scratch disease/ tularemia

• History of blood transfusion – Hepatitis A/B/C, CMV virus/ HIV

• History of Malar rash, alopecia/ cardiac disease/ Raynaud’s phenomenon – Systemic lupus erythematosus

• History of fever/ rash/ joint disease- Juvenile rheumatoid arthritis

• History of fever/ rash/ conjunctivitis/ skin peeling- Kawasaki disease

• History of hepatosplenomegaly/ growth failure/ delay in development- Storage diseases

• History of weight loss/ night sweats/ bone pain/ bleeds- Malignancy