Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Lymphadenitis and Lymphangitis 931

pestis); unilateral inguinal adenopathy due to pyogenic infections (S.

aureus or group A streptococcus) or cat-scratch disease

■Generalized adenopathy seen in many diseases, including brucel-

losis, infectious mononucleosis, toxoplasmosis, CMV, acute HIV,

secondary syphilis, disseminated tuberculosis or atypical mycobac-

terial disease, etc.

■Acute lymphangitis most commonly caused by group A streptococ-

cus and S. aureus; less common causes include other streptocooci,

Pasteurella multocida (following a cat or dog bite) and Spirillum

minor (rat-bite fever)

■Chronic nodular lymphangitis due to Sporothrix schenckii (sporoti-

chosis), nocardia and Mycobacterium marinum (swimming pool

granuloma); other fungi and atypical mycobacteria as well as leish-

mania also rare causes

Signs & Symptoms

■Acute lymphadenitis associated with swollen, tender, erythematous

node; localized cellulitis may be present; systemic symptoms of fever,

chills and malaise common

■Chronic lymphadenitis presents insidiously with swollen node that

may or may not be tender and usually not associated with systemic

symptoms

■Acute lymphangitis presents with a red streak from a primary site

of infection that extends to a regional lymph node; fever and chills

common; lymph node tender

■Chronic lymphangitis presents with a primary papule or nodule at

inoculation site with subcutaneous spread of nodules that follow

along lymphatic vessels; systemic symptoms usually absent

tests

■Blood cultures in febrile patient; culture of node if draining (culture

for bacteria, fungus and mycobacteria)

■Aspiration of node for culture and cytology in chronic cases; exci-

sional biopsy may be needed if aspiration fails to reveal etiology

■Serologic studies (syphilis, cat-scratch disease, toxoplasmosis, acute

HIV, mono spot or Epstein-Barr virus antibody titers) or skin test

(PPD) if history suggestive of specific disease

differential diagnosis

■Lymphoma, Kawasaki syndrome, Kikuchi Fujimoto’s disease (necro-

tizing histiocytic lymphadenitis), sarcoidosis, systemic lupus, Still’s

disease, Sjogren syndrome