Causes of Autoimmune Lymphoproliferative Syndrome
Autoimmune Lymphoproliferative Syndrome Causes: Book Excerpts
What causes Autoimmune Lymphoproliferative Syndrome?
Article excerpts about the
causes of Autoimmune Lymphoproliferative Syndrome:
To better understand how ALPS
works, imagine that you have a respiratory infection, perhaps the flu. The
cells in the nose and throat send out a message to the immune system to
start making more lymphocytes to fight the flu. New troops of lymphocytes
come to the nose and throat to seek out and destroy the cells infected
with the flu virus. Once the virus is conquered, the lymphocytes get a
message that their job is done and they are no longer needed. At this
point, it is normal for most of the fighter cells to disintegrate through
a process called apoptosis (a-pop-to'-sis).
The immune
systems of people with ALPS are efficient in fighting germs. The problem
in ALPS happens after an infection is gone. In ALPS, apoptosis does not
work as well as it should. In other words, the troops (lymphocytes) donÕt
hear the message that the war is over. As a result, excess T and B cells
gather in the lymph glands, liver and spleen. We can detect the extra
cells in people with ALPS by looking for high numbers of double-negative T
cells. In general, these extra T cells donÕt cause a
problem.
Sometimes in ALPS, the B cells make a mistake. Instead of
making antibodies to be custom-designed against germs, the B cells make
antibodies against platelets, red blood cells, or other cells. This causes
autoimmune problems. The antibodies become stuck to the platelets and red
blood cells, which then get stuck in the spleen. The spleen has to work
extra hard to filter out the sticky cells. This is another reason why the
spleen gets so big. (Source: excerpt from Autoimmune Lymphoproliferative Syndrome (ALPS): NIAID)
Related information on causes of Autoimmune Lymphoproliferative Syndrome:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Autoimmune Lymphoproliferative Syndrome may be found in:
Causes of Autoimmune Lymphoproliferative Syndrome: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the causes of Autoimmune Lymphoproliferative Syndrome.
Lymphadenopathy:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Generalized lymphadenopathy (e.g., cervical, supraclavicular, axillary, and inguinal lymphadenopathy; hepatomegaly; splenomegaly)
-
Infection
–Tuberculosis
–Secondary syphilis
–Mononucleosis
–HIV/AIDS
–Kawasaki's syndrome
–Typhoid fever -
Hypersensitivity reactions
–Serum sickness
–Drugs (e.g., hydantoin, phenytoin, hydralazine, allopurinol, primidone)
-
Lymphoma
-
Leukemia
-
Connective tissue disorders (e.g., SLE, rheumatoid arthritis)
-
Sarcoidosis
-
Metastatic cancer [especially with left supraclavicular lymphadenopathy (Virchow's node) associated with abdominal malignancies, including stomach, pancreas, gallbladder, testis/ovary, kidney, and prostate cancers]
-
Endocrine disorders (e.g., hyperthyroidism, hypoadrenalism)
-
Amyloidosis
-
Castleman's syndrome (angiofollicular lymph node hyperplasia)
-
Kikuchi's disease
Localized lymphadenopathy
-
Reactive hyperplasia, local inflammation (e.g., dermatitis, vaccination, trauma)
-
Infection
–Viral: Mononucleosis, CMV, HIV, rubella, mumps
–Bacterial: Streptococcus, tuberculosis, salmonella, cat-scratch disease (due to Bartonella henselae); gonorrhea, Chlamydia, and other sexually transmitted diseases (inguinal)
–Parasitic: Malaria, toxoplasmosis
–Fungal: Histoplasmosis,
coccidioidomycosis
- Lymphoma or metastatic disease (e.g. head
and neck squamous cell cancer leads to
cervical lymphadenopathy)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Lymphadenopathy:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Infectious
–Viral (URI, varicella, EBV, CMV, HIV, rubella, mumps, measles)
–Bacterial (strep, staph, mycobacterium, atypical mycobacterium, brucellosis, tularemia, syphilis, chlamydia)
–Fungal (histoplasmosis, coccidioidomycosis)
–Protozoal (toxoplasmosis, malaria)
–Scalp infection
-
Allergy
–Seasonal or individual
-
Inflammatory
–Kawasaki disease
–Sarcoidosis
–Cat-scratch disease (Bartonella henselae)
–Drug-induced (phenytoin, isoniazid,
hydralazine, dapsone, procainamide, allopurinol)
-
Malignancy
–Leukemia
–Hodgkin disease
–Non-Hodgkin lymphoma
–Neuroblastoma
–Rhabdomyosarcoma
–Histiocytic disorder
-
Collagen vascular disease or systemic illness
–Rheumatoid arthritis
–Systemic lupus erythematosus
–Serum sickness
–Autoimmune hemolytic anemia
–Cystic fibrosis
-
Immunodeficiency
-
Storage diseases
–Gaucher disease
–Niemann-Pick disease
-
Non-lymph node masses simulating
lympadenopathy
–Thyroglossal duct cysts
–Branchial cleft cysts
–Cystic hygroma
–Hemangioma
–Teratoma
–Thymoma
–Inguinal hernia
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Lymphadenopathy:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acquired immunodeficiency syndrome
Besides lymphadenopathy, findings include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and a cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous)
Lymphadenopathy, malaise, a headache, and a fever may develop along with a lesion that progresses into a painless, necrotic-centered ulcer.
Brucellosis
Generalized lymphadenopathy usually affects cervical and axillary lymph nodes, making them tender
Brucellosis usually begins insidiously with easy fatigability, malaise, headache, backache, anorexia, weight loss, and arthralgia; it may also begin abruptly with chills, a fever that usually rises in the morning and subsides during the day, and diaphoresis.
Cytomegalovirus infection
Generalized lymphadenopathy occurs in the immunocompromised patient and is accompanied by a fever, malaise, a rash, and hepatosplenomegaly.
Hodgkin’s disease
The extent of lymphadenopathy reflects the stage of malignancy — from stage I involvement of a single lymph node region to stage IV generalized lymphadenopathy
Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and an unexplained fever (usually to 101° F [38.3° C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Leptospirosis
Lymphadenopathy occurs infrequently in leptospirosis, a rare disease
More common findings include a sudden onset of a fever and chills, malaise, myalgia, a headache, nausea and vomiting, and abdominal pain.
Leukemia (acute lymphocytic)
Generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and a low-grade fever
The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
Leukemia (chronic lymphocytic)
Generalized lymphadenopathy appears early, along with fatigue, malaise, and a fever
As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease
Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans
As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, and an intermittent headache, a fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Mononucleosis (infectious)
Characteristic, painful lymphadenopathy involves cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms — such as a headache, malaise, and fatigue — occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, sore throat, and temperature fluctuations with an evening peak of about 102° F (38.9°C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Mycosis fungoides
Lymphadenopathy occurs in stage III of mycosis fungoides, a rare, chronic malignant lymphoma
It’s accompanied by ulcerated brownish red tumors that are painful and itchy.
Non-Hodgkin’s lymphoma
Painless enlargement of one or more peripheral lymph nodes is the most common sign of non-Hodgkin’s lymphoma, with generalized lymphadenopathy characterizing stage IV
Dyspnea, a cough, and hepatosplenomegaly occur, along with systemic complaints of a fever of up to 101° F (38.37 C), night sweats, fatigue, malaise, and weight loss.
Plague (Yersinia pestis)
and symptoms of the bubonic form of plague, a bacterial infection, include lymphadenopathy, a fever, and chills.
Rheumatoid arthritis
Lymphadenopathy is an early, nonspecific finding associated with fatigue, malaise, a continuous low-grade fever, weight loss, and vague arthralgia and myalgia
Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis
Generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common
Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, a cough, substernal chest pain, and arrhythmias. About 90% of patients have an abnormal chest X-ray at sometime during their illness. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Sjögren’s syndrome
Lymphadenopathy of the parotid and submaxillary nodes may occur in Sjögren’s syndrome, a rare disorder
Assessment reveals cardinal signs of dry mouth, eyes, and mucous membranes, which may be accompanied by photosensitivity, poor vision, eye fatigue, nasal crusting, and epistaxis.
Syphilis (secondary)
Generalized lymphadenopathy occurs in the second stage and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp
A palmar rash is a significant diagnostic sign. A headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, and a low-grade fever may occur.
Systemic lupus erythematosus
Generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud’s phenomenon, and joint pain and stiffness
Pleuritic chest pain and a cough may appear with systemic findings, such as a fever, anorexia, and weight loss.
Tuberculous lymphadenitis
Lymphadenopathy may be generalized or restricted to superficial lymph nodes
Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by a fever, chills, weakness, and fatigue.
Waldenström’s macroglobulinemia
Lymphadenopathy may appear along with hepatosplenomegaly
Associated findings include retinal hemorrhage, pallor, and signs of heart failure, such as jugular vein distention and crackles. The patient shows a decreased level of consciousness, abnormal reflexes, and signs of peripheral neuritis. Weakness, fatigue, weight loss, epistaxis, and GI bleeding may also occur. Circulatory impairment occurs because of increased blood viscosity.
Other causes
Drugs
Phenytoin may cause generalized lymphadenopathy.
Immunizations
Typhoid vaccination may cause generalized lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Lymphadenopathy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acquired immunodeficiency syndrome
Besides lymphadenopathy, findings include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous)
Lymphadenopathy, malaise, headache and fever may develop along with a lesion that progresses into a painless, necrotic-centered ulcer.
Brucellosis
Generalized lymphadenopathy usually affects cervical and axillary lymph nodes, making them tender. This disease usually begins insidiously with easy fatigability, malaise, headache, backache, anorexia, weight loss, and arthralgias; it may also begin abruptly with chills, fever that usually rises in the morning and subsides during the day, and diaphoresis.
Chronic fatigue syndrome
Lymphadenopathy may occur with incapacitating fatigue, sore throat, low-grade fevers, myalgia, cognitive dysfunction, and sleep disturbances. The diagnosis is one of exclusion and the cause of this syndrome is unknown.
Cytomegalovirus infection
Generalized lymphadenopathy occurs in the immunocompromised patient and is accompanied by fever, malaise, rash, and hepatosplenomegaly.
Hodgkin’s disease
The extent of lymphadenopathy reflects the stage of malignancy—from stage I involvement of a single lymph node region to stage IV generalized lymphadenopathy. Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and unexplained fever (usually to 101° F [38.3° C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Kawasaki syndrome
Cervical lymphadenopathy is a characteristic sign of this potentially life-threatening illness. Affected individuals present with high, spiking fever, along with other diagnostic signs including erythema, bilateral conjunctival injection, and swelling in the peripheral extremities. Kawasaki syndrome isn’t contagious, however the cause remains unknown and typically affects children under age 5. Prompt detection and treatment with I.V. gamma globulin is essential in preventing serious complications, such as coronary artery dilations and aneurysms.
Leptospirosis
Lymphadenopathy occurs infrequently in this rare disease. More common findings include sudden onset of fever and chills, malaise, myalgia, headache, nausea and vomiting, and abdominal pain.
Leukemia (acute lymphocytic)
Generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and low fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
Leukemia (chronic lymphocytic)
Generalized lymphadenopathy appears early, along with fatigue, malaise, and fever. As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease
Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans. As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, and intermittent headache, fever, chills, and aches. He may go on to develop arthralgias and, eventually, neurologic and cardiac abnormalities.
Monkeypox
Lymphadenopathy is the one symptom that clearly distinguishes monkeypox from smallpox. Humans infected with monkeypox usually develop cervical or inguinal lymphadenopathy, along with other characteristic symptoms such as fever, chills, throat pain, muscle aches, and rash. This rare viral disease acquired its name after being discovered in laboratory monkeys; however, many other animals can carry this disease. Although the monkeypox virus is similar to smallpox, the smallpox vaccine is only used in limited circumstances to protect certain at-risk individuals against the disease.
Mononucleosis (infectious)
Characteristic, painful lymphadenopathy involves cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Prodromal symptoms, such as malaise, fatigue, and headache, typically occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, sore throat, and temperature fluctuations with an evening peak of about 102° F (38.9° C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Mycosis fungoides
Lymphadenopathy occurs in stage III of this rare, chronic malignant lymphoma and is accompanied by ulcerated brownish red tumors that are painful and itchy.
Non-Hodgkin’s lymphoma
Painless enlargement of one or more peripheral lymph nodes is the most common sign of this disease, with generalized lymphadenopathy characterizing stage IV. Dyspnea, cough, and hepatosplenomegaly occur, along with systemic complaints of fever to 101° F (38.3° C), night sweats, fatigue, malaise, and weight loss.
Plague
(Yersinia pestis). Signs and symptoms of the bubonic form of this bacterial infection include lymphadenopathy, fever, and chills.
Rheumatoid arthritis
Lymphadenopathy is an early, nonspecific finding associated with fatigue, malaise, continuous low fever, weight loss, and vague arthralgias and myalgias. Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis
Generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common. Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, cough, substernal chest pain, and arrhythmias. About 90% of patients have an abnormal chest X-ray at sometime during their illness. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Sjögren’s syndrome
Lymphadenopathy of the parotid and submaxillary nodes may occur in this rare disorder. Assessment reveals cardinal signs of dry mouth, eyes, and mucous membranes, which may be accompanied by photosensitivity, poor vision, eye fatigue, nasal crusting, and epistaxis.
Syphilis (primary)
Localized lymphadenopathy and a painless ulcer (canker) with an indurated border and relatively smooth base at the site of sexual exposure characterize this infection. The ulcer is usually single but more than one may be present.
Syphilis (secondary)
Generalized lymphadenopathy occurs in the second stage and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp. A palmar rash is a significant diagnostic sign. Headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, and low fever may occur.
Systemic lupus erythematosus
Generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud’s phenomenon, and joint pain and stiffness. Pleuritic chest pain and cough may appear with systemic findings, such as fever, anorexia, and weight loss.
Tuberculous lymphadenitis
Lymphadenopathy may be generalized or restricted to superficial lymph nodes. Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by fever, chills, weakness, and fatigue.
Waldenström’s macroglobulinemia
Lymphadenopathy may appear along with hepatosplenomegaly. Associated findings include retinal hemorrhage, pallor, and signs of heart failure, such as jugular vein distention and crackles. The patient shows decreased level of consciousness, abnormal reflexes, and signs of peripheral neuritis. Weakness, fatigue, weight loss, epistaxis, and GI bleeding may also occur. Circulatory impairment occurs because of an increased viscosity of the blood.
Other causes
Drugs
Phenytoin may cause generalized lymphadenopathy.
Immunizations
Typhoid vaccination may cause generalized lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Lymphadenopathy:
Differential Overview
(Field Guide to Bedside Diagnosis)
Generalized
❑ Infectious mononucleosis
❑ Drugs
❑ Connective tissue disease
❑ HIV infection
❑ Sarcoidosis
❑ Serum sickness
❑ Toxoplasmosis
❑ Secondary syphilis
Localized
❑ Regional infection
❑ Lymphadenitis
❑ Hodgkin lymphoma
❑ Cat-scratch disease
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Chronic fatigue and immune dysfunction syndrome:
Causes
(Handbook of Diseases)
Although the cause of CFIDS is unknown, researchers suspect that it may be found in human herpesvirus 6 or in other herpesviruses, enteroviruses, or retroviruses. Rising levels of antibodies to EBV, once thought to implicate EBV infection as the cause of CFIDS, are now considered a result of this disease.
CFIDS may be associated with a reaction to viral illness that’s complicated by dysfunctional immune response and by other factors that may include sex, age, genetic disposition, prior illness, stress, and environment.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Lymphadenopathy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acquired immunodeficiency syndrome
Besides lymphadenopathy, acquired immunodeficiency syndrome (AIDS) findings include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous)
With cutaneous anthrax, lymphadenopathy, malaise, headache, and fever may develop along with a small, elevated, itchy lesion resembling an insect bite that progresses into a painless, necrotic-centered ulcer.
Chronic fatigue syndrome
Lymphadenopathy may occur with incapacitating fatigue, sore throat, low-grade fevers, myalgia, cognitive dysfunction, and sleep disturbances. The patient may also experience arthralgia with arthritis, headache, and memory deficits.
Cytomegalovirus infection
Generalized lymphadenopathy is accompanied by fever, malaise, and hepato-splenomegaly in a patient infected with cytomegalovirus. The patient also develops a pruritic rash of small, erythematous macules that progresses to papules and then to vesicles.
Hodgkin’s disease
In Hodgkin’s disease, the extent of lymphadenopathy reflects the stage of malignancy, from stage I involvement of a single lymph node region to stage IV — generalized lymphadenopathy. Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and unexplained fever (usually to 101° F [38.3° C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Leukemia
In acute lymphocytic leukemia, generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and low fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
In chronic lymphocytic leukemia, generalized lymphadenopathy appears early, along with fatigue, malaise, and fever. As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease
Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans. As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, and intermittent headache, fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Mononucleosis (infectious)
Patients with mononucleosis develop painful lymphadenopathy that involves the cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms — such as headache, malaise, and fatigue — occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, sore throat, and temperature fluctuations with an evening peak of about 102° F (38.9° C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Non-Hodgkin’s lymphoma
Painless enlargement of one or more peripheral lymph nodes is the most common sign of non-Hodgkin’s lymphoma, with generalized lymphadenopathy characterizing stage IV. Dyspnea, cough, and hepatosplenomegaly occur, along with systemic complaints of fever to 101° F (38.3° C), night sweats, fatigue, malaise, and weight loss.
Rheumatoid arthritis
Lymphadenopathy is an early, nonspecific finding of rheumatoid arthritis that’s associated with fatigue, malaise, continuous low fever, weight loss, and vague arthralgia and myalgia. Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis
Generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common in sarcoidosis. Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, cough, substernal chest pain, and arrhythmias. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Syphilis
Localized lymphadenopathy and a painless ulcer (canker) with an indurated border and relatively smooth base at the site of sexual exposure characterize a primary syphilis infection. The ulcer is usually single, but more than one may be present. In the second stage of syphilis, generalized lymphadenopathy occurs and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp. A palmar rash is a significant diagnostic sign. Headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, and low fever may occur.
Systemic lupus erythematosus
Generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud’s phenomenon, and joint pain and stiffness associated with systemic lupus erythematosus (SLE). Pleuritic chest pain and cough may appear with systemic findings, such as fever, anorexia, and weight loss.
Tuberculous lymphadenitis
With tuberculous lymphadenitis, lymphadenopathy may be generalized or restricted to superficial lymph nodes. Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by fever, chills, weakness, and fatigue.
Other causes
Drugs
Phenytoin may cause generalized lymphadenopathy.
Immunizations
Typhoid vaccination may cause generalized lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Lymphadenopathy:
Principal Causes of Localized Lymphadenopathy
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Localizedlymphadenopathy
- Cervical
- Submandibular/submental
- Preauricular
- Postauricular
- Occipital
- Supraclavicular
- Axillary
- Epitrochlear
- Inguinal
- Femoral
- Popliteal
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Lymphadenopathy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acquired immunodeficiency syndrome (AIDS).Besides lymphadenopathy, findings with AIDS include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and a cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous).Lymphadenopathy, malaise, headache, and fever may develop with cutaneous anthrax, along with a lesion that progresses into a painless, necrotic-centered ulcer.
Brucellosis.With brucellosis, generalized lymphadenopathy usually affects cervical and axillary lymph nodes, making them tender. It usually begins insidiously with easy fatigability, malaise, a headache, backache, anorexia, weight loss, and arthralgia; it may also begin abruptly with chills, a fever that usually rises in the morning and subsides during the day, and diaphoresis.
Cytomegalovirus infection (CMV).CMV causes generalized lymphadenopathy occurs in the immunocompromised patient and is accompanied by fever, malaise, rash, and hepatosplenomegaly.
Hodgkin's disease.The extent of lymphadenopathy with Hodgkin's disease reflects the stage of malignancy—from stage I involvement of a single lymph node region to stage IV generalized lymphadenopathy. Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and an unexplained fever (usually up to 101º F [38.3º C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Kawasaki syndrome.Cervical lymphadenopathy is a characteristic sign of Kawasaki syndrome, a potentially life-threatening illness. Affected individuals present with a high, spiking fever, along with other diagnostic signs including erythema, bilateral conjunctival injection, and swelling in the peripheral extremities. Kawasaki syndrome isn't contagious, however the cause remains unknown and the disease typically affects children under age 5. Prompt detection and treatment with I.V. gamma globulin is essential in preventing serious complications, such as coronary artery dilations and aneurysms.
Leptospirosis.Lymphadenopathy is uncommon in leptospirosis, a rare disease. More common findings include a sudden onset of a fever and chills, malaise, myalgia, a headache, nausea and vomiting, and abdominal pain.
Leukemia (acute lymphocytic).With acute lymphocytic leukemia, generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and a low-grade fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
Leukemia (chronic lymphocytic).With chronic lymphocytic leukemia, generalized lymphadenopathy appears early, along with fatigue, malaise, and a fever. As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease.Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans. As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, an intermittent headache, a fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Monkeypox.Lymphadenopathy is the one symptom that clearly distinguishes monkeypox from smallpox. Humans infected with monkeypox usually develop cervical or inguinal lymphadenopathy, along with other characteristic symptoms such as fever, chills, throat pain, muscle aches, and rash. This rare viral disease acquired its name after being discovered in laboratory monkeys; however, many other animals can carry this disease. Although the monkeypox virus is similar to smallpox, the smallpox vaccine is only used in limited circumstances to protect certain at-risk individuals against the disease.
Mononucleosis (infectious).With infectious mononucleosis, characteristic, painful lymphadenopathy involves cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms—such as a headache, malaise, and fatigue—occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, a sore throat, and temperature fluctuations with an evening peak of about 102º F (38.9º C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Mycosis fungoides.Lymphadenopathy occurs in stage III of mycosis fungoides, a rare, chronic malignant lymphoma. It's accompanied by ulcerated brownish red tumors that are painful and itchy.
Non-Hodgkin's lymphoma.Painless enlargement of one or more peripheral lymph nodes is the most common sign of non-Hodgkin's lymphoma, with generalized lymphadenopathy characterizing stage IV. Dyspnea, a cough, and hepatosplenomegaly occur, along with systemic complaints of a fever of up to 101° F (38.3º C), night sweats, fatigue, malaise, and weight loss.
Plague (Yersinia pestis).Signs and symptoms of the bubonic form of plague, a bacterial infection, include lymphadenopathy, a fever, and chills.
Rheumatoid arthritis.Lympha-
denopathy is an early, nonspecific finding in rheumatoid arthritis and is associated with fatigue, malaise, a continuous low-grade fever, weight loss, and vague arthralgia and myalgia. Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis.With sarcoidosis, generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common. Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, a cough, substernal chest pain, and arrhythmias. About 90% of patients have an abnormal chest X-ray at some time during their illness. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Sjögren's syndrome.Lymphadenopathy of the parotid and submaxillary nodes may occur in Sjögren's syndrome, a rare disorder. Assessment reveals cardinal signs of dry mouth, eyes, and mucous membranes, which may be accompanied by photosensitivity, poor vision, eye fatigue, nasal crusting, and epistaxis.
Syphilis (secondary).Generalized lymphadenopathy occurs in the second stage of syphilis and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp. A palmar rash is a significant diagnostic sign. Headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, and low-grade fever may occur.
Systemic lupus erythematosus (SLE).With SLE, generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud's phenomenon, and joint pain and stiffness. Pleuritic chest pain and a cough may appear with systemic findings, such as a fever, anorexia, and weight loss.
Tuberculous lymphadenitis.Lymphadenopathy that occurs with tuberculous lymphadenitis may be generalized or restricted to superficial lymph nodes. Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by a fever, chills, weakness, and fatigue.
Waldenström's macroglobulinemia.
Lymphadenopathy may appear along with hepatosplenomegaly in Waldenström's macroglobulinemia. Associated findings include retinal hemorrhage, pallor, and signs of heart failure, such as jugular vein distention and crackles. The patient shows a decreased level of consciousness, abnormal reflexes, and signs of peripheral neuritis. Weakness, fatigue, weight loss, epistaxis, and GI bleeding may also occur. Circulatory impairment occurs because of increased blood viscosity.
Other causes
Drugs.Phenytoin may cause generalized lymphadenopathy.
Immunizations.Typhoid vaccination may cause generalized lymphadenopathy.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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