Lymphadenopathy: Difference between revisions

Latest revision as of 18:19, 20 January 2021

Background

Refers to enlargement of the lymph nodes

Differential Diagnosis

Neoplasm
- Hematologic: lymphoma, leukemia
- Solid tumour: squamous cell cancer of the head and neck
- Metastasis
Infection
- Viral: HIV, EBV, HSV, CMV, mumps, measles, rubella, hepatitis B, dengue
- Bacterial
  - Regional: streptococcal pharyngitis, skin and soft tissue infection, tularemia, plague, cat scratch disease, diphtheria, chancroid, rat bite fever, Lyme disease
  - Generalized: brucellosis, leptospirosis, lymphogranuloma venereum, typhoid fever, secondary syphilis
- Mycobacterial: tuberculosis, non-tuberculous mycobacteria
- Fungal: histoplasmosis, coccidiomycosis, cryptococcosis
- Parasitic: toxoplasmosis, leishmaniasis
Non-neoplastic lymphoproliferative disorders
Immune-mediated
- Serum sickness
- Drug reactions: allopurinol, atenolol, captopril, carbamazepine, cephalosporins, ethosuximide, gold, hydralazine, imatinib, lamotrigine, penicillin, phenytoin, primidone, pyrimethamine, quinidine, sulfonamides, sulindac
- IgG4-related disease
Endocrine and metabolism
- Addison disease
- Lipid storage disease
Other

Differential by Location

Cervical: EBV, CMV, toxoplasmosis, tuberculosis or non-tuberculous mycobacteria (if more chronic with less tenderness), cat scratch disease, metastatic head-and-neck cancer
Preauricular: conjunctivitis, Parinaud oculoglandular syndrome (cat scratch disease)
Postauricular: parietotemporal scalp infection, rubella
Suboccipital: posterior scalp infection
Supraclavicular: malignancy (especially intraabdominal malignancy)
Axillary: infections of the arm (including cat scratch disease), malignancy (including breast and metastasis), foreign body reaction to silicone breast implants
Epitrochlear: infections of the forearm or hand, lymphoma, sarcoidosis, tularemia, and secondary syphilis
Inguinal: trauma, lower limb infections, STIs (chancroid, LGV, herpes, syphilis), malignancy (including skin on legs, cervix, vulva, skin on trunk, rectum/anus, ovary, penis)
Generalized:
- More common: HIV, tuberculosis, mononucleosis, lupus, medications, sarcoidosis, lymphoma
- Less common: Castleman disease, Kikuchi disease, Kawasaki disease, angioimmunoblastic T-cell lymphoma, inflammatory pseudotumour, amyloidosis, Kimura disease, progressive transformation of germinal centres, Fosai-Dorfman disease, IgG4-related disease

Causes by risk factor

Animal exposure
- Cat: cat-scratch disease, toxoplasmosis
Undercooked meat: toxoplasmosis
Tick bite: Lyme disease, tularemia
Tuberculosis: tuberculous adenitis
Transfusion or transplant: CMV, HIV
High-risk sexual behaviour: HIV, syphilis, HSV, CMV, hepatitis B
Intravenous drug use: HIV, endocarditis, hepatitis B
Occupational
- Hunters and trappers: tularemia
- Fishermen and butchers: erysipeloid
Travel-related
- Arizona, southern California, New Mexico, and western Texas: coccidiomycosis
- Southwestern US: plague
- Southeastern or central US: histoplasmosis
- Southeast Asia, India, or northern Australia: scrub typhus
- Central or west Africa: African trypanosomiasis
- Central or South America: American trypanosomiasis
- East Africa, Mediterranean, China, or South/Central America: leishmaniasis
- Mexico, Peru, Chile, India, Pakistan, Egypt, or Indonesia: typhoid fever

@@ Line 1: / Line 1: @@
+==Background==
-== Differential Diagnosis ==
+*Refers to enlargement of the lymph nodes
-* Neoplasm
-** Hematologic: lymphoma, leukemia
-** Solid-tumour: squamous cell cancer of the head and neck
-** Metastasis
-* Infection
-** Viral: HIV, EBV, HSV, CMV, mumps, measles, rubella, hepatitis B, dengue
-** Bacterial
-*** Regional: streptococcal pharyngitis, skin and soft tissue infections, tularemia, plague, cat scratch disease, diphtheria, chancroid, rat bite fever, Lyme disease
-*** Generalized: brucellosis, leptospirosis, lymphogranuloma venereum, typhoid fever, secondary syphilis
-** Mycobacterial: tuberculosis, non-tuberculous mycobacteria
-** Fungal: histoplasmosis, coccidiomycosis, cryptococcosis
-** Parasitic: toxoplasmosis, leishmaniasis
-* Non-neoplastic lymphoproliferative disorders
-** Angioimmunoblastic lymphadenopathy with dysproteinemia
-** Autoimmune lymphoproliferative disease
-** Rosai-Dorfman disease
-** Hemophagocytic lymphohistiocytosis
-* Immune-mediated
-** Serum sickness
-** Drug reactions: allopurinol, atenolol, captopril, carbamazepine, cephalosporins, ethosuximide, gold, hydralazine, imatinib, lamotrigine, penicillin, '''phenytoin''', primidone, pyrimethamine, quinidine, sulfonamides, sulindac
-** IgG4-related disease
-* Endocrine and metabolism
-** Addison disease
-** Lipid storage disease
-* Other
-** Sarcoidosis
-** Multicentric Castleman disease
-** Amyloidosis
-** Histiocytosis
-** Chronic granulomatous disease
-** Kikuchi disease
-** Kawasaki disease
-** Inflammatory pseudotumor
-** Systemic lupus erythematosus
-** Rheumatoid arthritis
-** Still disease
-** Dermatomyositis
-** Eosinophilic granulomatosis with polyangiitis
+==Differential Diagnosis==
-=== Causes by location ===
+*Neoplasm
-* '''Cervical:''' EBV, CMV, toxoplasmosis, tuberculosis or non-tuberculous mycobacteria (if more chronic with less tenderness), cat scratch disease, metastatic head-and-neck cancer
+**Hematologic: [[lymphoma]], [[leukemia]]
-* '''Preauricular:''' conjunctivitis, Parinaud oculoglandular syndrome (cat scratch disease)
+**Solid tumour: [[squamous cell cancer]] of the head and neck
-* '''Postauricular:''' parietotemporal scalp infection, rubella
+**[[Metastasis]]
-* '''Suboccipital:''' posterior scalp infection
+*Infection
-* '''Supraclavicular:''' malignancy (especially intraabdominal malignancy)
+**Viral: [[HIV]], [[EBV]], [[HSV]], [[CMV]], [[mumps]], [[measles]], [[rubella]], [[hepatitis B]], [[dengue]]
-* '''Axillary:''' infections of the arm (including cat scratch disease), malignancy (including breast and metastasis), foreign body reaction to silicone breast implants
+**Bacterial
-* '''Epitrochlear:''' infections of the forearm or hand, lymphoma, sarcoidosis, tularemia, and secondary syphilis
+***Regional: [[streptococcal pharyngitis]], [[skin and soft tissue infection]], [[tularemia]], [[plague]], [[cat scratch disease]], [[diphtheria]], [[chancroid]], [[rat bite fever]], [[Lyme disease]]
-* '''Inguinal:''' trauma, lower limb infections, STIs (chancroid, LGV, herpes, syphilis), malignancy (including skin on legs, cervix, vulva, skin on trunk, rectum/anus, ovary, penis)
+***Generalized: [[brucellosis]], [[leptospirosis]], [[lymphogranuloma venereum]], [[typhoid fever]], [[secondary syphilis]]
-* '''Generalized:'''
+**Mycobacterial: [[tuberculosis]], [[non-tuberculous mycobacteria]]
-** '''More common:''' HIV, tuberculosis, mononucleosis, lupus, medications, sarcoidosis, lymphoma
+**Fungal: [[histoplasmosis]], [[coccidiomycosis]], [[cryptococcosis]]
-** '''Less common:''' Castleman disease,Kikuchi disease, Kawasaki disease, angioimmunoblastic T-cell lymphoma, inflammatory pseudotumour, amyloidosis, Kimura disease, progressive transformation of germinal centres, Fosai-Dorfman disease, IgG4-related disease
+**Parasitic: [[toxoplasmosis]], [[leishmaniasis]]
+*Non-neoplastic [[lymphoproliferative disorders]]
+**[[Angioimmunoblastic lymphadenopathy with dysproteinemia]]
+**[[Autoimmune lymphoproliferative disease]]
+**[[Rosai-Dorfman disease]]
+**[[Hemophagocytic lymphohistiocytosis]]
+*Immune-mediated
+**[[Serum sickness]]
+**Drug reactions: [[allopurinol]], [[atenolol]], [[captopril]], [[carbamazepine]], [[cephalosporins]], [[ethosuximide]], [[gold]], [[hydralazine]], [[imatinib]], [[lamotrigine]], [[penicillin]], '''[[phenytoin]]''', [[primidone]], [[pyrimethamine]], [[quinidine]], [[sulfonamides]], [[sulindac]]
+**[[IgG4-related disease]]
+*Endocrine and metabolism
+**[[Addison disease]]
+**[[Lipid storage disease]]
+*Other
+**[[Sarcoidosis]]
+**[[Multicentric Castleman disease]]
+**[[Amyloidosis]]
+**[[Histiocytosis]]
+**[[Chronic granulomatous disease]]
+**[[Kikuchi disease]]
+**[[Kawasaki disease]]
+**[[Inflammatory pseudotumor]]
+**[[Systemic lupus erythematosus]]
+**[[Rheumatoid arthritis]]
+**[[Still disease]]
+**[[Dermatomyositis]]
+**[[Eosinophilic granulomatosis with polyangiitis]]
-=== Causes by risk factor ===
+===Differential by Location===
+*'''Cervical:''' [[EBV]], [[CMV]], [[toxoplasmosis]], [[tuberculosis]] or [[non-tuberculous mycobacteria]] (if more chronic with less tenderness), [[cat scratch disease]], metastatic head-and-neck cancer
-* '''Animal exposure'''
+*'''Preauricular:''' [[conjunctivitis]], [[Parinaud oculoglandular syndrome]] ([[cat scratch disease]])
+*'''Postauricular:''' [[parietotemporal scalp infection]], [[rubella]]
+*'''Suboccipital:''' posterior scalp infection
+*'''Supraclavicular:''' [[malignancy]] (especially intraabdominal malignancy)
+*'''Axillary:''' infections of the arm (including [[cat scratch disease]]), [[malignancy]] (including breast and metastasis), foreign body reaction to silicone breast implants
+*'''Epitrochlear:''' infections of the forearm or hand, [[lymphoma]], [[sarcoidosis]], [[tularemia]], and [[secondary syphilis]]
+*'''Inguinal:''' trauma, lower limb infections, [[Sexually-transmitted infection|STIs]] ([[chancroid]], [[LGV]], [[Herpes simplex virus|herpes]], [[syphilis]]), [[malignancy]] (including skin on legs, cervix, vulva, skin on trunk, rectum/anus, ovary, penis)
+*'''Generalized:'''
+**'''More common:''' [[HIV]], [[tuberculosis]], [[mononucleosis]], [[lupus]], medications, [[sarcoidosis]], [[lymphoma]]
+**'''Less common:''' [[Castleman disease]], [[Kikuchi disease]], [[Kawasaki disease]], [[angioimmunoblastic T-cell lymphoma]], [[inflammatory pseudotumour]], [[amyloidosis]], [[Kimura disease]], progressive transformation of germinal centres, [[Fosai-Dorfman disease]], [[IgG4-related disease]]
+===Causes by risk factor===
-* '''Cat:''' cat-scratch disease, toxoplasmosis
-** '''Undercooked meat:''' toxoplasmosis
-** '''Tick bite:''' Lyme disease, tularemia
-** '''Tuberculosis:''' tuberculous adenitis
-** '''Transfusion or transplant:''' CMV, HIV
-** '''High-risk sexual behaviour:''' HIV, syphilis, HSV, CMV, hepatitis B
-** '''Intravenous drug use:''' HIV, endocarditis, hepatitis B
-* '''Occupational'''
+*'''Animal exposure'''
+**'''Cat:''' [[cat-scratch disease]], [[toxoplasmosis]]
-* '''Hunters and trappers:''' tularemia
+*'''Undercooked meat:''' [[toxoplasmosis]]
-** '''Fishermen and butchers:''' erysipeloid
+*'''Tick bite:''' [[Lyme disease]], [[tularemia]]
-* '''Travel-related'''
+*'''Tuberculosis:''' [[tuberculous adenitis]]
-* '''Arizona, southern California, New Mexico, and western Texas:''' coccidiomycosis
+*'''Transfusion or transplant:''' [[CMV]], [[HIV]]
-** '''Southwestern US:''' plague
+*'''High-risk sexual behaviour:''' [[HIV]], [[syphilis]], [[HSV]], [[CMV]], [[hepatitis B]]
-** '''Southeastern or central US:''' histoplasmosis
+*'''Intravenous drug use:''' [[HIV]], [[endocarditis]], [[hepatitis B]]
-** '''Southeast Asia, India, or northern Australia:''' scrub typhus
+*'''Occupational'''
-** '''Central or west Africa:''' African trypanosomiasis
+**'''Hunters and trappers:''' [[tularemia]]
-** '''Central or South America:''' American trypanosomiasis
+**'''Fishermen and butchers:''' [[erysipeloid]]
-** '''East Africa, Mediterranean, China, or South/Central America:''' leishmaniasis
+*'''Travel-related'''
-** '''Mexico, Peru, Chile, India, Pakistan, Egypt, or Indonesia:''' typhoid fever
+**'''Arizona, southern California, New Mexico, and western Texas:''' [[coccidiomycosis]]
+**'''Southwestern US:''' [[plague]]
+**'''Southeastern or central US:''' [[histoplasmosis]]
+**'''Southeast Asia, India, or northern Australia:''' [[scrub typhus]]
+**'''Central or west Africa:''' [[African trypanosomiasis]]
+**'''Central or South America:''' [[American trypanosomiasis]]
+**'''East Africa, Mediterranean, China, or South/Central America:''' [[leishmaniasis]]
+**'''Mexico, Peru, Chile, India, Pakistan, Egypt, or Indonesia:''' [[typhoid fever]]
 [[Category:Infectious diseases]]