Lymph Node Enlargement
Causes of generalized lymphadenopathy
Generalized lymphadenopathy is always a puzzling entity. The presence of fever may suggest an infectious cause or lymphoma. The presence of rash may suggest an infectious or autoimmune process. Request a full blood count to exclude hematological causes. A lymph node biopsy is needed if the picture is suggestive of lymphoma.
Essentially 5 broad etiologic categories lead to lymph node enlargement (Ghirardelli, 1999).
- An immune response to infective agents (eg, bacteria, virus, fungus)
- Inflammatory cells in infections involving the lymph node
- Infiltration of neoplastic cells carried to the node by lymphatic or blood circulation (metastasis)
- Localized neoplastic proliferation of lymphocytes or macrophages (eg, leukemia, lymphoma)
Infiltration of macrophages filled with metabolite deposits (eg, storage disorders)
- Infectious mononucleosis.
- Cytomegalovirus may cause a syndrome similar to infectious mononucleosis.
- TB: In a child with tuberculosis, generalized lymphadenopathy may indicate hematogenous spread of tubercle bacilli.
- Brucellosis may accompany chronic or intermittent lymphadenopathy.
- Salmonella infection can correspond to generalized adenopathy.
- Tularemia may be accompanied by regional or generalized adenopathy, most commonly cervical, with local tenderness, pain, and fever.
- Bubonic plague is caused by Y pestis.
Immunologic or connective tissue disorders
- Juvenile rheumatoid arthritis should be considered in unexplained fever and persistent lymphadenopathy in a child.
- Serum sickness can correspond with generalized tender lymphadenopathy.
- Chronic graft versus host disease.
Primary disease of lymphoid or reticuloendothelial tissue
- Acute leukemia
- Hodgkin disease
- Non-Hodgkin lymphoma
- Nonendemic Burkitt tumor
- Nasopharyngeal rhabdomyosarcoma
- Reticulum cell sarcoma
- Malignant histocytosis or histocytic lymphoma
- Thyroid carcinoma, chronic lymphocytic thyroiditis
- Histiocytosis X
- Benign sinus histiocytosis
- Angioimmunoblastic or immunoblastic lymphadenopathy
- Chronic pseudolymphomatous lymphadenopathy (chronic benign lymphadenopathy)
- Acquired immunodeficiency syndrome
- Chronic granulomatous disease of childhood
- Hyperimmunoglobulin E (Job) syndrome
Metabolic and storage diseases
- Gaucher disease
- Histiocytosis X
- Niemann-Pick disease
- Congenital hemolytic anemia
- Autoimmune hemolytic anemia
- Sickle cell anemia
- Sarcoidosis demonstrate either generalized or hilar lymphadenopathy.
- Drug: mesantoin, hydantoin use may produce lymphadenopathy as an adverse effect.
- Castleman disease or benign giant lymph node hyperplasia may cause lymphadenopathy in the mediastinum, abdomen, neck, or axilla.
- Kawasaki disease
1. Ghirardelli ML, Jemos V, Gobbi PG: Diagnostic approach to lymph node enlargement. Haematologica 1999 Mar; 84(3): 242-7.
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