Lymphadenopathy

Adult

• General approach: Suspicious lymphadenopathy

• Infectious

  • Acute: Acute laryngitis (URI), Epstein-Barr virus, Cytomegalovirus, Adenovirus

  • HIV

• Malignant

  • Hodgkin lymphoma

  • Non-Hodgkin lymphoma

  • Chronic lymphocytic leukemia (CLL)

  • Metastatic solid tumor

Pediatric

Axillary

Differential

• Cat scratch disease (B. henselae): Axillary lymphadenitis in 50% of cases. Consider Bartonella IFA but do not I&D. Self-limiting (1 to 2 months). Treatment is controversial in immunocompetent patients; consider azithromycin x 5 days.

• Pyogenic infection of arm (S. Aureus)

Treatment

• If < 2 cm

  • Administer Augmentin x 5 days if h/o cat exposure

  • If no resolution 2-3 weeks after initial antibiotic treatment:

    • Obtain CBC with differential, tuberculin skin test (PPD)

    • Treat for MRSA infection

  • If CBC, PPD normal and no resolution after treatment for MRSA: Biopsy

• If ≥ 2 cm: Obtain CBC, ESR/CRP, Bartonella IFA, and CXR. If no resolution after 2-3 weeks, obtain biopsy.

Additional Locations

• Occipital

  • Head/scalp infections: Seborrheic dermatitis, tinea capitis, lice

  • Roseola virus (HHV6)

  • Insect bites

• Auricular

  • Anterior: Conjunctivitis

  • Posterior: Roseola virus (HHV6), rubella

• Submental and submaxillary: Dental infections, GBS infection (infants < 2 months)

• Cervical

  • Anterior

    • Oropharyngeal infection

    • Viral infection: URI, EBV, CMV

    • Bacterial: B. henselae, mycobacterium

  • Posterior: Epstein-Barr virus, rubella

• Supraclavicular: Lymphoma, metastatic malignancy

• Epitrochlear: Hand infection, viral disease, sarcoidosis

• Inguinal

  • STI (genital herpes, Gonorrhea, Syphilis)

  • Lymphoma