Lymphadenitis

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Background

  • Lymphadenitis = inflammation of lymph node
  • Can be single or multiple
  • Most commonly due to viral or bacterial (usually staph or strep) infection local to region draining lymph to that node
  • Pyogenic organisms may cause suppurative infection/abscess
  • Not to be confused with lymphangitis

Clinical Features

  • Pain
  • Erythema
  • Enlargement over time
  • Associated symptoms:
    • Fever
    • Local signs of infection depending on location of lymph node
      • Cervical
        • URI symptoms
        • Conjunctivitis
        • Mouth sores, dental infection
      • Axillary
        • Breast infections
        • Upper-limb infections
      • Mesenteric
        • Abdominal pain, nausea/vomiting
      • Inguinal
        • GU infections
        • Lower-limb infections

Differential Diagnosis

Infectious

Non-Infectious

Evaluation

  • Usually clinical diagnosis
  • If associated exudative pharyngitis, consider Rapid GAS testing
  • If severe symptoms (ill-appearing, high fever), consider:
    • Basic labs (CBC, BMP)
    • Blood cultures
    • ESR/CRP may be helpful for monitoring course of infection/response to treatment
    • Ultrasound to evaluate for associate abscess or deep locations
  • If subacute/chronic, consider:
    • CBC, BMP, ESR/CRP
    • Uric acid, LDH
    • Tuberculin skin test

Management

  • Mild symptoms (well appearing, absent/low-grade fever, minimal tenderness)
    • Serial exams, PMD follow-up
    • PO Antibiotic treatment if associated GAS pharyngitis found
  • Moderate symptoms (fever, tenderness without fluctuance)
    • Empiric PO Antibiotic therapy that covers S. Aureus and GAS
    • Consider anaerobic coverage if found to have poor dentition or evidence of periodontal disease
  • Severe symptoms (ill-appearing, fever, fluctuance or overlying cellulitis)
    • Incision & Drainage or Needle Aspiration
    • IV Antibiotics

Disposition

  • Generally can be discharged with outpatient follow-up/treatment if mild/moderate symptoms
  • Admit for:
    • Sepsis/Severe symptoms requiring I&D or IV antibiotics
    • Failure of outpatient treatment

External Links

References

  • Dulin MF, Kennard TP, Leach L, Williams R. Management of cervical lymphadenitis in children. Am Fam Physician 2008; 78:1097.