LYMPHADENOPATHY
Ask the Following Questions:
- Is there a history of drug ingestion? Many drugs can cause lymphadenopathy; the most notable is Dilantin, but the antibiotics, aspirin, iodides, and certain antihypertensive drugs can cause lymphadenopathy also.
- Is the lymphadenopathy focal or diffuse? If the adenopathy is focal, one should look for an infectious process in the area supplied by the respective lymph nodes. For example, if there is occipital node enlargement, one would look for ringworm, dermatitis of the scalp, furunculosis, pediculosis, and cellulitis. However, infectious mononucleosis and rubella may begin with enlargement of these nodes.
- Is there fever? The presence of fever should make one think of infectious mononucleosis, brucellosis, dengue fever, toxoplasmosis, and Still's disease, among other diseases.
DIAGNOSTIC WORKUP
Routine diagnostic tests include a CBC, sedimentation rate, nose and throat culture, and culture of material from any area supplied by the enlarged lymph nodes. Blood cultures are indicated in generalized lymphadenopathy. In addition, a chemistry panel should be done, as well as a heterophile antibody titer, brucellin antibody titer, febrile agglutinins, and VDRL test. A chest x-ray and flat plate of the abdomen may be helpful in diagnosing generalized lymphadenopathy. HIV testing is done in patients with a history of high-risk sexual behavior.
X-ray of the long bones may identify metastatic carcinoma, and x-ray of the hands may identify sarcoidosis. A bone marrow examination may identify leukemia or lymphoma. If an infectious process has been ruled out, biopsy of the local node may turn up metastatic carcinoma, Hodgkin's disease, and sarcoidosis. A tuberculin skin test should be done; a Brucellergen skin test and Kveim test may also need to be done. ANA and
rheumatoid arthritis factor
testing may need to be done to rule out a collagen disease. A lymphangiogram may turn up a lymphosarcoma or multiple metastatic lymph nodes. Liver biopsy is also occasionally necessary. Imaging studies of the abdomen and pelvis and the mediastinum are occasionally necessary. Mediastinoscopy may facilitate getting a tissue diagnosis. Before ordering these, a consultation with a hematologist or infectious disease specialist would be prudent.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Lymph symptoms
Read excerpts from these other book chapters related to Lymph symptoms:
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Lymph symptoms
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Lymphadenopathy (In a Page: Signs and Symptoms)
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