Important aspects of the history in a child with peripheral lymphadenopathy

Historical feature	Potential significance/examples
Location, onset, adenopathy	Affects the most likely etiologies
Local symptoms of infection	Cough: Pneumonia (bacterial, viral, fungal) Sore throat: GAS, adenovirus, diphtheria
Horner syndrome (miosis, ptosis, anhidrosis) or opsoclonus myoclonus	Neuroblastoma, rhabdomyosarcoma
Constitutional symptoms (eg, fever weight loss, night sweats, arthralgias, skin rash)	May indicate malignancy, Mycobacterium tuberculosis, rheumatologic disease, or Kikuchi disease; fever is not helpful in discriminating infectious and noninfectious causes
Dental problems or mouth sores	Anaerobic infection, actinomycosis, enteroviral herpangina, HSV gingivostomatitis, Langerhans cell histiocytosis
Skin lesions or trauma	Staphylococcus aureus, GAS, HSV, cat scratch disease (Bartonella henselae), tularemia, bubonic plague (Yersinia pestis), diphtheria
Exposures
Ill contacts	Viral respiratory infections, CMV, EBV, GAS, M. tuberculosis
Unpasteurized animal milk	Brucellosis, Mycobacterium bovis
Undercooked meats	Toxoplasmosis, tularemia
Animals:
Cats	Cat scratch disease, toxoplasmosis
Goats	Brucellosis
Rabbits	Tularemia
Prairie dogs	Bubonic plague
Fish tanks	Mycobacterium marinum
Tick bites, flea bites, biting flies or mosquitoes	Lyme disease, bubonic plague, tularemia, filariasis
Travel	Depending on geographic region, may increase risk of certain infections (eg, tularemia, bubonic plague, M. tuberculosis*, measles, rubella, filariasis, leishmaniasis, typhoid fever)
Sexual activity	Sexually transmitted infections; hepatitis B infection
Past medical history
Medication history: Allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, pyrimethamine, quinidine, sulfonamides, sulindac	Associated with lymphadenopathy
History of asthma	Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
History of recurrent infections, skin abscesses, suppurative adenitis	Chronic granulomatous disease
Autoimmune disease	Autoimmune lymphoproliferative syndrome
Immunization status	Diphtheria, measles, rubella (if not immunized)

GAS: group A Streptococcus; HSV: herpes simplex virus; CMV: cytomegalovirus; EBV: Epstein-Barr virus.
* Refer to individual UpToDate topic reviews for the epidemiology of specific infections.

Data from:

Greenfield S, Jordan MC. The clinical investigation of lymphadenopathy in primary care practice. JAMA 1978; 240:1388.
Knight PJ, Mulne AF, Vassy LE. When is lymph node biopsy indicated in children with enlarged peripheral nodes? Pediatrics 1982; 69:391.
Malley R. Lymphadenopathy. In: Textbook of Pediatric Emergency Medicine, 5^th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams and Wilkins, Philadelphia 2006. p.421.
Margileth AM. Sorting out the causes of lymphadenopathy. Contemp Pediatr 1995; 12:23.
Morland B. Lymphadenopathy. Arch Dis Child 1995; 73:476.
Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993; 20:570.

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Important aspects of the history in a child with peripheral lymphadenopathy