What Is Lymphadenitis?

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Lymphadenitis is the inflammation of the lymph nodes, usually as the result of an infection. Although bacteria, viruses, and fungi are the most common causes, lymphadenitis may also result from cancer and other inflammatory conditions. As a symptom of an underlying disease, lymphadenitis may require blood tests, lab cultures, tissue biopsy, and imaging studies to pinpoint the cause and identify the appropriate treatment.

Types of Lymphadenitis

There around 600 lymph nodes scattered in clusters throughout the body, including under the arms (axillary), in the groin (inguinal), around the neck and jawline (cervical), and within the chest (mediastinal) or abdominal cavities (mesenteric).

The extent of lymphadenitis is based on whether the condition is confined to a part of the body or is systemic (body-wide):

  • Localized lymphadenitis involves one or more lymph nodes near the site of an infection.
  • Generalized lymphadenitis involves two or more regions of the body as a part of a more pervasive, systemic disease.

When diagnosing lymphadenitis, doctors will often describe it by its location, extent, duration, and/or underlying disease. Examples include mediastinal tuberculosis lymphadenitis, HIV-associated persistent generalized lymphadenitis (PGL), or acute inguinal lymphadenitis.

Lymphadenitis vs. Lymphadenopathy

Lymphadenitis is sometimes used interchangeably with lymphadenopathy, although the two conditions are distinct. Lymphadenitis indicates an underlying inflammatory process, whereas lymphadenopathy simply describes the abnormal enlargement or consistency of the lymph nodes for any number of reasons.

Lymphadenitis Symptoms

The symptoms and severity of lymphadenitis can vary by the underlying cause and nodes involved, and may include:

  • Abnormal swelling of the lymph nodes
  • Tenderness or pain when touched
  • Redness or streaking of the overlying skin
  • A rubbery or mushy feel (if there is an abscess)
  • Fluid drainage onto the skin

Fever, chills, loss of appetite, and fatigue may also occur if the cause is infectious. If cancer is involved, the lymph nodes may be hard, immovable, non-tender and be accompanied by night sweats, unexplained weight loss, or itchy skin.

A lymph node is usually considered enlarged if it over half an inch in diameter, although some lymph nodes (like the epitrochlear nodes in the inner forearm) may be enlarged if they are over a quarter of an inch in size.

Causes

Lymph nodes are an important part of the immune system, which works to isolate disease-causing pathogens so that specialized white blood cells (lymphocytes) can kill them.

Lymphadenitis occurs when a foreign body triggers an inflammatory response within the lymph node. While there are infectious and non-infectious causes of lymphadenitis, the presence of this inflammation is a defining feature irrespective of the cause.

Infectious Causes

Infections account for the majority of lymphadenitis cases. Streptococcal and staphylococcal bacteria are the most common causes, although viruses, fungi, protozoa, and other bacteria can also cause lymphadenitis.

Localized lymphadenitis is commonly associated with infections like:

Generalized lymphadenitis is commonly associated with infections like:

There are also unique cases in which lymphadenitis is unilateral (on one side of the body), such as with herpes zoster (shingles).

In addition to disease, lymphadenitis can occur as a result of exposure to toxins or certain medications, including penicillin, Dilantin (phenytoin), sulfonamides, gold, and quinidine.

Non-Infectious Causes

There are a number of autoimmune disorders that can cause acute lymphadenitis, including rheumatoid arthritis, Sjögren's syndrome, and lupus. Rare diseases, like Castleman disease, Kimura disease, and Kikuchi-Fujimoto disease, can also cause severe lymph node inflammation.

Lymphadenitis is also a feature of certain cancers, including blood cancers like leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma.

Diagnosis

Lymphadenitis is a symptom rather than its own disease. You cannot diagnose the cause of lymphadenitis based purely on whether lymph nodes in your neck, armpit, or groin are swollen. Only with the appropriate tests and exams can a doctor determine the cause and recommend treatment.

The process begins with a physical exam along with a review of your symptoms and medical history. The location, size, and characteristics of the affected lymph nodes can suggest the possible causes of lymphadenitis. Other symptoms may point the doctor in the direction of an infection, autoimmune disease, or cancer.

Based on these characteristics, lymphadenitis may be considered:

  • Diagnosed, such as with strep throat or an upper respiratory infection, in which the diagnostic signs are strong enough to recommend treatment
  • Suggested, such as with mononucleosis of HIV, in which the location of the lymphadenitis and the history of the patient can direct the doctor to the appropriate diagnostic tests
  • Unexplained, in which there is no clear indication of the underlying cause of localized or generalized lymphadenitis

To confirm the underlying cause of lymphadenitis, there are a number of tests a doctor can use:

Based on these findings, your doctor may order additional tests or start treatment presumptively if an uncomplicated infection is involved.

Treatment

The treatment of lymphadenitis can vary widely based on the underlying cause. In some cases, only supportive care is needed to manage symptoms. In others, prescription drugs and other treatments may be needed.

Supportive Care

To help relieve symptoms of lymph node inflammation, your doctor may recommend certain home and over-the-counter remedies like:

Prescriptions

If time and rest are not enough to bring an infection under control, prescription medications may be used. These include:

Systemic and chronic infections may require different or more extensive therapies, including immunosuppressive drugs for autoimmune diseases, chemotherapy or radiation therapy for cancer, and life-long antiretroviral therapy for HIV.

Corticosteroid drugs, which relieve inflammation by tempering the immune response, should not be used until a definitive diagnosis is made as they can mask the underlying cause, such as leukemia, lymphoma, or TB.

Surgery

Lymphadenitis is rarely treated with surgery, with the exception of abscess drainage to remove pus from an infected node (typically done in tandem with antibiotic therapy).

Surgery may also be appropriate in the management of certain types of cancer. In cases of metastasis, some or all of the lymph nodes surrounding the primary tumor may be removed in a procedure known as lymphadenectomy.

For lymphoma or leukemia, surgery is rarely used other than for diagnostic purposes.

In cases like cellulitis, surgery is avoided due to the risk of spreading the infection.

A Word From Verywell

Swollen and inflamed lymph nodes are something that most people with experience at some point in their life, and most cases are caused by a treatable infection. But chronic lymphadenitis should never be considered normal no matter how mild it is. If a node is large enough for you to notice and swelling doesn't resolve on its own, make an appointment to see a doctor.

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