LYMPHADENOPATHY, GENERALIZED
LYMPHADENOPATHY, GENERALIZED: Excerpt from Differential Diagnosis in Primary Care
Many of the conditions that cause splenomegaly also cause generalized
lymphadenopathy. They are best recalled with the use of the mnemonic
MINT.
M—Malformations include sickle cell anemia and other congenital
hemolytic anemias, the reticuloendothelioses (Niemann–Pick disease,
Hand–Schüller–Christian disease, and Gaucher disease), and
lymphangiomas.
I—Inflammatory disorders constitute the largest group of
lymphadenopathies. Breaking them down into subgroups according to the size
of the organism further assists the recall.
-
Viral illnesses include infectious mononucleosis,
lymphogranuloma venereum, German measles, chickenpox, and viral upper
respiratory illnesses. There are many other conditions in this category.
- Rickettsial diseases include typhus and Rocky Mountain spotted
fever.
- Bacterial diseases include typhoid, plague, tuberculosis, skin
infections, tularemia, meningococcemia, and brucellosis.
- Spirochetes include syphilis and Borrelia vincentii.
- Parasites include malaria, filariasis, and trypanosomiasis.
- Fungi include histoplasmosis, disseminated coccidioidomycosis,
and blastomycosis.
N—Neoplasms Dissemination of almost every malignancy may cause
generalized lymphadenopathy. The most likely ones to present with
generalized lymphadenopathy, however, are lymphatic leukemia, monocytic
leukemia, Hodgkin lymphoma, and lymphosarcoma. Myelophthisic anemia must be
considered too.
T—Toxic disorders that cause generalized lymphadenopathy are
numerous. Dilantin toxicity may mimic Hodgkin lymphoma. Drug allergies from
sulfonamides, hydralazine, and iodides are just a few of the others.
In addition to the conditions listed above, systemic diseases
that may cause lymphadenopathy include the autoimmune disorders such as
lupus erythematosus (50% of the cases with lupus erythematosus are
associated with lymphadenopathy), dermatomyositis, sarcoidosis, and Still
disease.
Approach to the Diagnosis
Obviously, it is tempting simply to do a lymph node biopsy, but certain
other procedures should be done first. If the patient is febrile, febrile
agglutinins, monospot test, blood cultures, and cultures of any other
suspicious body fluid should be made. A fluorescent treponemal antibody
absorption test (FTA-ABS) test should be done as well as a chest x-ray and
tuberculin test to rule out tuberculosis. A blood count usually shows
leukemia, but a bone marrow biopsy may be necessary to diagnose leukemia, Hodgkin lymphoma, and
the reticuloendothelioses. Other x-rays, skin tests, and special diagnostic
procedures may be necessary.
Other Useful Tests
-
CBC (infection, leukemia)
- Sedimentation rate (inflammation)
- Chemistry panel (liver disease, kidney disease)
- Brucellin antibody titer (brucellosis)
- X-ray of the long bones (metastatic neoplasm)
- Kveim test (sarcoidosis)
- Brucellergen skin test (brucellosis)
- Lyme disease antibody titer
- Lymphangiogram (lymphosarcoma)
- CT scan of the abdomen and pelvis (Hodgkin lymphoma, lymphoma)
- CT scan of the mediastinum (lymphoma, metastatic neoplasm)
- ANA analysis (collagen disease)
- Skin tests for fungi (histoplasmosis, e.g.)
