In some cases, lymphadenitis remains asymptomatic. When symptomatic, the lymph node may be swollen and palpable with pain and tenderness. Neck stiffness is a common symptoms with cervical lymph node enlargement and often seen in infectious mononucleosis and cat scratch fever. Preauricular lymphadenitis is common in infections like conjunctivitis, and keratoconjunctivitis. Inflammation of the retropharyngeal node causes dysphagia and dyspnea. Patients with node enlargement in mediastinum may present with cough, stridor, pleural effusion, and dysphagia. Abdominal pain is common in cases where the intraabdominal nodes are enlarged and in iliac node enlargement. Supraclavicular lymphadenopathy has the highest risk of malignancy. Malignancy often results in hard, nontender, and firm nodes. Lymph node enlargement caused by infections is soft, tender and movable. Erythema of the skin is noted in some of the swollen nodes associated with infectious diseases. In many cases, the manifestations of the underlying disease may appear only after the initial lymph gland inflammation or enlargement.

Increased risk of lymphadenitis is seen in patients who have a clinical history of upper respiratory tract infection, conjunctivitis, persistent fever, and anorexia. Those who have a history of contact with animals or livestock also are at a high-risk of developing this condition.

• Chills

  After completion of 4 cycles of ipilimumab for the treatment of metastatic melanoma, our patient complained of increasing fatigue, drenching night sweats, and chills. Imaging revealed diffuse adenopathy involving several lymph nodes. [ncbi.nlm.nih.gov]

  Contact your doctor at the first signs of infection (fever, chills, redness). Take steps to prevent getting an infection: Practice good hygiene practices, such as washing your hands regularly. Avoid close contact with people who are sick. [knowyourdisease.com]

  Further developments include fever with chills, loss of appetite, heavy perspiration, a rapid pulse, and general weakness. [healthofchildren.com]

  Some of the common symptoms of Cervical Lymphadenitis are: Swelling of the lymph nodes in neck Swelling of the lymph nodes under jaw Presence of lumps under skin Swelling in the neck Pain in the neck Facial swelling Fever and chills Persistent sore throat [epainassist.com]

  […] of the causes of lymphadenitis Contact with animals, specifically cats, rats, or cows Symptoms Symptoms include: Swollen, painful, tender, or hard lymph nodes/glands The skin over a node is red and warm to the touch Fever with the following symptoms: Chills [cancercarewny.com]

• Sepsis

  Abstract A 29-year-old woman presented with neutropenic sepsis and was found to have a new diagnosis of acute myeloid leukaemia. [ncbi.nlm.nih.gov]

  A ten-year review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J 1990 ; 9 : 819 –25. ↵ Fernandez M, Rench MA, Albanyan EA, et al. [adc.bmj.com]

  Sepsis and septic shock. Merck Manual Professional Edition. https://www.merckmanuals.com/professional/SearchResults?query=sepsis+and+septic+shock. Accessed May 20, 2016. Overview of gastroenteritis. [mayoclinic.org]

  Possible Complications Untreated lymphadenitis may lead to: Abscess formation Cellulitis (a skin infection) Fistulas (seen in lymphadenitis that is due to tuberculosis) Sepsis (bloodstream infection) When to Contact a Medical Professional Call your provider [baptistjax.com]

• Hodgkin Lymphoma

  lymphoma Non-Hodgkin lymphomas Squamous cell carcinomas of nasopharyngeal or laryngeal structures Axillary lymph nodes Axillary lymph nodes receive lymphatic drainage from upper extremities and breasts. [emedicine.medscape.com]

  Enlarged lymph nodes that do not cause pain, tenderness, or redness may indicate a serious different disorder, such as lymphoma, tuberculosis, or Hodgkin lymphoma. Such lymph nodes require a doctor’s attention. [msdmanuals.com]

• Wound Infection

  Depending on the duration and intensity of the inflammatory process, there are: acute lymphadenitis, which is characterized by a sudden onset and occurs as a result of wound infection, the development of an acute infectious disease, or after surgery; [en.medicine-worlds.com]

  The surgical wound healed completely without clinical or ultrasound evidence of recurrence of NTM infection at the 3- and 6-month evaluation in 48 patients (96%). [academic.oup.com]

  One study examined 360 children undergoing excisional biopsy and found that 24 percent of patients had complications, such as hypertrophic scarring, recurrence, hematoma formation, wound infection, and nerve palsy, that were related to the procedure. [aafp.org]

• Lymphedema

  The diseases or disorders of the lymphatic system and lymph nodes include lymphedema, lymphadenopathy and so forth. (1-5) Lymphedema Lymphedema is where Edema, or fluid collection, leads to swelling of limbs and other regions drained by the affected lymphatic [news-medical.net]

  If it's not working properly, fluid builds in your tissues and causes swelling, called lymphedema. Other lymphatic system problems can include infections, blockage, and cancer. [icdlist.com]

• Ulcer

  Shortly after the diagnosis, oral aphthae, erythema nodosum-like lesions on the lower legs and genital ulcers developed. [ncbi.nlm.nih.gov]

  One should take care to treat skin ulcers promptly and appropriately. Lymphadenitis refers to the inflammation of the lymph nodes resulting in swollen and tender lymph glands. [symptoma.com]

  The discharge from sinus may infect the surrounding skin and cause extensive tuberculous ulcer. Ulcers have a typical pale, flabby, granulation tissue, under-mined edges, and a seropurulent discharge. 9. [de.slideshare.net]

• Skin Ulcer

  ulcers Enlarged liver and enlarged spleen If the infection occurs on the skin it is called cutaneous leishmaniasis. [dovemed.com]

  Avoiding skin injury, insect bites, and scratches on the skin will go a long way in preventing infections and thus lymphadenitis. One should take care to treat skin ulcers promptly and appropriately. [symptoma.com]

• Insect Bite

  (Etiology) Leishmania Lymphadenitis is caused by the bite of sandflies; small flying insects (3-6 mm in size) that are smaller than mosquitoes and less noisy. [dovemed.com]

  Avoiding skin injury, insect bites, and scratches on the skin will go a long way in preventing infections and thus lymphadenitis. One should take care to treat skin ulcers promptly and appropriately. [symptoma.com]

• Skin Lesion

  Biopsy of the skin lesion C. PCR D. Serology Board review answer #1 D. Serology Serology for IgG and IgM antibodies for Bartonella henslae is confirmatory for cat scratch disease. Biopsy is rarely indicated. [pathologyoutlines.com]

• Neck Swelling

  Some of the common symptoms of Cervical Lymphadenitis are: Swelling of the lymph nodes in neck Swelling of the lymph nodes under jaw Presence of lumps under skin Swelling in the neck Pain in the neck Facial swelling Fever and chills Persistent sore throat [epainassist.com]

  The patient first noted the neck swelling in April 1996. CT scan of the neck was obtained, revealing bilateral cervical and left submandibular lymphadenopathy. [academic.oup.com]

  A total of 140 patients with enlargement of cervical lymph node or swelling of the neck or draining sinus presenting to different specialties of our hospital were studied in detail. [ijmyco.org]

• Neck Stiffness

  Cervical lymphadenitis can lead to neck stiffness and torticollis. [emedicine.medscape.com]

  When it appears in the neck, it can cause pain, neck stiffness and redness of the skin over the lymph nodes. Lymphadenitis also commonly causes of fevers. [livestrong.com]

  stiffness Diagnosis You will be asked about your symptoms and medical history. [cancercarewny.com]

• Irritability

  The boy was breast fed and developed well until the age of 28 days when he became irritable. The consulting paediatrician noticed a submandibular mass on the right side as well as increasing irritability. [adc.bmj.com]

  Definition / general Type of paracortical hyperplasia, commonly occurring in lymph nodes draining areas with chronic skin irritation Essential features Paracortical expansion with nodular proliferation of interdigitating dendritic cells, Langerhans cells [pathologyoutlines.com]

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

In children the cervical, inguinal and axillary lymph nodes generally show a swelling up to 12 years of age, after which it reduces in size. The first step towards diagnosis would be take a complete medical history of the patient to check for risk factors. Physical exam up to look for local infections including scalp, ears, nose, upper respiratory tract and chest would help to diagnose underlying cause, if present. A thorough systemic examination is conducted to check for symptoms of malignancy, particularly in the abdominal region. In any case, five factors are important in diagnosis [5]:

• Size
• Pain or tenderness
• Consistency
• Matting
• Location

Initial evaluation of the lymphadenitis focuses at the region of primary lymph node enlargement. The second line tests including skin testing for tuberculosis, antinuclear antibody test, hepatitis B serology tests, HIV tests and imaging and are based on specific indications. This is particularly true of persistent generalized lymphadenitis. A number of laboratory studies help in diagnosing the cause of lymphadenitis. Bacterial infections can be diagnosed with the help of Gram staining. The organism can be identified through culture of the specimen. Leukocytosis is indicative of infectious diseases that lead to lymphadenitis. Erythrocyte sedimentation rate, and CRP levels show an increase and are indicative of inflammation. 

Correct measurements of the enlarged lymph node can be taken using ultrasonography. But this may not be useful in differentiating a malignant lymph node enlargement. Biopsy is suggested if the condition is not related to any local infection or if it has been there for more than four to six weeks. Biopsy is also the procedure if the affected node is supraclavicular or ulcerated. Presence of symptoms like prolonged fever and weight loss calls for a biopsy of the lymph node tissue. To obtain specimen for diagnosis, fine needle aspiration is used except when malignancy is suspected. The affected lymph node is drained after incision if abscesses are found, but this procedure is avoided in the case of lymphadenitis caused by mycobacterial infection, as it may lead to the formation of fistula.

• Staphylococcus Aureus

  Options include IV antibiotics, typically directed at Staphylococcus aureus and Streptococcus pyogenes; antifungals; and antiparasitics depending on etiology or clinical suspicion. [msdmanuals.com]

  Condition Major Pathogens First Choice Therapy Alternative Therapy Comments Lymphadenitis - acute, suppurative bacterial, usually unilateral Staphylococcus aureus Group A streptococcus Occasional anaerobes Clindamycin 10mg/kg/dose PO/IV q8h (max 600mg [idmp.ucsf.edu]

  aureus or group A streptococcus are indicated. [aafp.org]

Treatment of lymphadenitis mainly depends on the underlying cause for inflammation of the lymph nodes [6]. Investigation and consultation is required particularly if the inflammation persists for more than six weeks or increase in size [7]. Treatment may include analgesics, antibiotics, chemotherapy or radiation depending on the cause. If the lymph node enlargement is present for two weeks or lesser, and if the size is less than 3 cm, expectant management of the condition is the suggested treatment option. If the nodes are tender and is larger than 2-3 cm, particularly with erythema of the overlying skin, antimicrobial treatment, usually with clindamycin, is recommended [8]. Local guidelines are followed in case of tuberculosis. Chemotherapy and radiotherapy are suggested for malignancies of different types.

In some cases, incision and drainage may be required, particularly for large nodes. Incision is also required for getting aspirate for a diagnostic culture. When the etiology of lymphadenitis is confirmed, the patient may be referred to specialist based on the underlying cause. Further consultations may be with an infectious disease specialist, hematologist, dermatologist, a surgeon or a radiologist, based on the etiology. In most of the cases, the inflammation may resolve when the underlying condition is treated successfully.

Prognosis for this condition depends on the underlying condition that causes lymphadenitis. If lymph node enlargement is caused by malignancies, the condition has a poor prognosis. Other conditions like HIV infection, rheumatoid arthritis and SLE also has increased and prolonged morbidity. Further, the presence of complications like abdominal lymphadenitis may alter the prognosis of the disease condition. But in most of the cases, prognosis is good with early diagnosis and treatment. Treatment with antibiotics aids in reducing infections and improving the prognosis. Those who have elevated risk of infections may have to undergo prolonged antibiotic therapy. Many of them may show recurrence of the infection too. In some cases, the enlargement may resolve within few weeks of prompt treatment, while in some the swelling remain for months.

One of the most common causes of lymphadenitis is infections. Apart from infectious conditions, neoplasms and some vascular disorders also may lead to lymph node inflammation [1]. Infectious diseases like cat scratch fever, pharyngitis, toxoplasmosis, shingles, tuberculosis, mononucleosis and scarlet fever are known to cause enlargement of lymph glands. Sexually transmitted diseases that result in lymphadenitis include syphilis, chancroid, hepatitis B, HIV infection, and lymphogranuloma venereum. A number of neoplasms also manifest in the form of lymph node inflammation and includes metastatic melanoma, prostatic cancer, breast cancer, renal carcinoma, Kaposi’s sarcoma, neuroblastoma, and lympholytic and myelocytic leukemia. Other systemic diseases including systemic lupus erythematosus (SLE), and rheumatoid arthritis are also known to cause inflammation of the lymph nodes. Some rare causes of this condition include hyperthyroidism, Gaucher disease, and sarcoidosis.

Regional lymphadenitis often serves as an indicator for further clinical investigation of underlying diseases [2]. Inflammation of supraclavicular lymph nodes point to the presence of lung or gastrointestinal cancer. Axillary node enlargement is common in cat scratch fever, breast cancer, melanoma, brucellosis, and other infectious diseases. Epitrochlear node inflammation frequently occurs in syphilis, lymphoma and sarcoidosis. Inguinal node enlargement is indicative of lymphoma, pelvic malignancy, or sexually transmitted diseases.
In some rare cases, medications are also known to cause lymph node enlargement and include drugs like sulphonamides, atenolol, captopril, penicillin, cephalosporin and hydralazine.

Reliable population estimates of incidence of this condition are rare. Results of a Dutch study showed that the incidence of this condition in the generalized population is about 0.6%[3]. In this study conducted on 2,556 patients, only 1.1% had malignancy of any form. Unexplained forms of lymphadenitis are rare and found only in 1% of the population with this condition [4]. The risk of cancer is about 4% in people above 40 years with unexplained lymphadenitis. The risk of cancer decreases considerably (0.4%) in people below this age. About three fourth of the all lymphadenitis are localized in nature. In most of the cases, inflammation of the node is caused by a specific pathology in the drainage of lymph in the area. About 25% of the cases requires further investigation for underlying disease to rule out chances of diseases like HIV infection, and tuberculosis.

Under normal conditions lymph nodes show a hyperplastic response to infections as a part of the body’s defense system to prevent diseases. The inflammation may resolve on its own within few weeks once the threat is contained. But in some cases, enlargement may remain, particularly during prolonged or severe forms of infection. Lymph node enlarge in size when an infection is drained into the local lymph gland. The area of involvement of lymph node enlargement will be limited when the underlying disease is localized. In a systemic disease, on the other hand, node involvement will be generalized. Enlargement of the node ensues when lymphocytes, plasma cells or monocytes undergo multiplication within the node. Enlargement is also noted when the node is infiltrated by malignant cells or neutrophils. 

The best way to prevent lymphadenitis is prompt diagnosis and treatment of bacterial and viral infections, both of which are common causes of lymph node enlargement [9]. Maintaining good health and general health is equally important in warding off infections of any kind. Avoiding skin injury, insect bites, and scratches on the skin will go a long way in preventing infections and thus lymphadenitis. One should take care to treat skin ulcers promptly and appropriately.

Lymphadenitis refers to the inflammation of the lymph nodes resulting in swollen and tender lymph glands. Lymph nodes are an integral part of the lymphatic system and are found distributed in clusters throughout the body. These nodes help to trap and filter disease-causing organisms and other abnormal cells from the lymph, thus aiding in fighting infections.

Lymphadenitis is a common symptom in many diseases. Many infections result in localized lymph node enlargement and the common regions where lymph node enlargement is present include cervical, axillary and inguinal lymph glands. Postauricular, supraclavicular and epitrochlear lymph node enlargement is relatively uncommon. Inflammation may be localized or generalized, and affecting a single node or a group of nodes.

Lymphadenitis refers to the inflammation of the lymph nodes present along the lymphatic vessels in the body. These nodes play an important role in fighting infections by filtering disease-causing organisms and other abnormal objects from the lymph. Many bacterial and viral infections result in swelling of the lymph nodes in different parts of the body. In most of the cases, the swollen glands are present near the site of infection. Tumors and some metabolic diseases also result in swollen lymph glands. This condition is often seen after infection by bacteria such as Streptococcus or Staphylococcus.

Lymphadenitis may be seen in any age group. The most common symptom of this condition is the swelling of the lymph nodes which may be tender or hard. The skin covering the node may become tender with or without reddish streaks. Lymphadenitis may be confined to one region or scattered in different parts. If a patient has difficulty in breathing or rapid heartbeat along with swollen lymph glands, it represents a life threatening situation and should seek immediate medical care.

The doctor may start with a complete physical exam and feel the characteristics of the swelling in the lymph nodes. This will help to look out for any signs of infection or injury close to the swollen glands. Biopsy is suggested to check the cause of inflammation. Treatment of lymphadenitis depends on the underlying cause for inflammation. Analgesics may help in controlling pain. If infection is the underlying cause for the swelling, antibiotics are recommended. Swelling can be reduced by anti-inflammatory drugs. Other medications are recommended based on the specific reason that leads to swelling in nodes. If tumors are the cause for swelling, radiation therapy or chemotherapy may be opted. Surgery may be suggested to drain the abscess from the node.

In most of the cases, inflammation of the lymph glands resolve on their own. It may take a few weeks for the swelling to disappear after the treatment. Early diagnosis and treatment are very important in the success of the treatment. But in some cases the swelling may persist and lead to complications.

1. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician. 1998;58(6):1313-1320.
2. Habermann T, Steensma D. Lymphadenopathy. Mayo Clinic Proc. 2000;75(7):723-732.
3. Fijten G, Blijham G. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Prac. 1988;27:373-376.
4. Richner S, Laifer G. Peripheral lymphadenopathy in immunocompetent adults. Swiss Med Wkly. 2010;140(7):98-104.
5. Morland B. Lymphadenopathy. Arch Dis Child. 1995;73:476-479.
6. Dulin M, Kennard T, Leach L, Williams R. Management of cervical lymphadenitis in children. Am Fam Physician. 2008;78(9):1097-1098.
7. Chau I, Kelleher M, Cunningham D. Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550. Br J Cancer. 2003;88(3):98-104.
8. Guss J, Kazahaya K. Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. International Journal of Pediatric Otorhinolaryngology. 2007;71(6):943-948. doi:10.1016/j.ijporl.2007.03.006.
9. Holme H, Nanduri V. Superior vena cava obstruction: Dangers of a missed diagnosis. Journal of Paediatrics and Child Health. 2011;47(3):150-151. doi:10.1111/j.1440-1754.2010.01741.x.