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Peripheral lymphadenopathy in children: Etiology

Peripheral lymphadenopathy in children: Etiology
Literature review current through: Jan 2024.
This topic last updated: Nov 28, 2022.

INTRODUCTION — Lymphadenopathy is common. It is usually not clinically important in and of itself. However, it can represent serious underlying disease. The challenge for clinicians is to avoid aggressive evaluation and biopsy of most children, while making timely, specific diagnoses in children with serious underlying disease.

The causes of peripheral lymphadenopathy in children will be reviewed here (table 1A-B and table 2). The information is intended to provide a framework for the approach to the evaluation of peripheral lymphadenopathy in children and to supplement clinical judgment in the absence of research that directly addresses how children with unexplained lymphadenopathy should be evaluated.

The approach to the child with peripheral lymphadenopathy, cervical lymphadenitis, and the causes and evaluation of peripheral lymphadenopathy in adults are discussed separately. (See "Cervical lymphadenitis in children: Etiology and clinical manifestations" and "Peripheral lymphadenopathy in children: Evaluation and diagnostic approach" and "Evaluation of peripheral lymphadenopathy in adults".)

ANATOMY AND DEFINITIONS — The location of peripheral lymph node groups is shown schematically in the figures (figure 1 and figure 2). Normal lymph nodes in most regions usually are less than 1 cm in their longest diameter; normal lymph nodes in the epitrochlear region usually are less than 0.5 cm in diameter, and normal lymph nodes in the inguinal region usually are less than 1.5 cm in diameter. Normal lymph nodes tend to be larger in childhood (ages 2 to 10 years) than later in life. Lymph nodes often are palpable in the inguinal region in healthy individuals, perhaps because chronic trauma and infection are so common in the lower extremities. Lymph nodes also may be palpable in the neck (particularly submandibular lymph nodes) because of previous head and neck infections.

PATHOGENESIS — Lymph node enlargement may be caused by [1]:

Replication of cells within the node in response to antigenic stimuli (as occurs in infections or serum sickness) or as a result of malignant transformation

Entry of large numbers of cells exogenous to the node (eg, neutrophils or metastatic neoplastic cells)

Deposition of foreign material within histiocytic cells of the node (as occurs in lipid storage diseases)

Vascular engorgement and edema secondary to local cytokine release

Suppuration secondary to tissue necrosis

EPIDEMIOLOGY — Children frequently have palpable lymph nodes because their immune systems are being activated by environmental antigens and the common organisms to which they are exposed. The prevalence of lymphadenopathy in the various lymph node groups varies with age and site [2,3]. Small occipital and postauricular nodes, for example, are common in infants, but not in older children [2]. In contrast, cervical and inguinal nodes are more common after two years of age than in the first six months of life [2,3]. Epitrochlear and supraclavicular adenopathy are uncommon at any age.

In one review, 44 percent of children younger than five years who were seen for well-child visits and 64 percent of those seen for "sick" visits had lymphadenopathy [2]. Most of the children with adenopathy detected at "sick" visits were between three and five years of age.

Many patients with unexplained lymphadenopathy (and their clinicians) are concerned about the possibility of malignancy. The prevalence of malignancy among patients seen in the primary care setting is relatively low [4,5]. In contrast, the prevalence of malignancy in lymph node biopsies performed in pediatric referral centers ranges from 13 to 27 percent [3,6,7].

In the largest of these series, 239 children underwent peripheral lymph node biopsies for evaluation of lymphadenopathy [3]. The following etiologies were noted:

Reactive hyperplasia of undetermined cause – 52 percent

Granulomatous disease (eg, cat scratch disease, atypical mycobacteria, Mycobacterium tuberculosis, fungal infections, or Langerhans cell histiocytosis [histiocytosis X]) – 32 percent

Neoplastic disease – 13 percent; among these two-thirds had Hodgkin disease

Chronic dermatopathic or bacterial infections – 3 percent

In another series of 159 children with cervical lymphadenopathy who underwent excisional biopsy for size >1.5 cm, persistence for >3.5 months (median time), and unresponsiveness to antimicrobial therapy, 40 percent were diagnosed with reactive hyperplasia, 39 percent with lymphoma, and 16 percent with granulomatous lymphadenitis [8].

A systematic review of causes of cervical lymphadenopathy in 2687 children from Italy, Turkey, India, Egypt, and Nigeria provides a more global view of causes [9]. Sixty-eight percent of children had nonspecific diagnoses, 9 percent had Epstein-Barr virus, 4.7 percent had malignancies, 4 percent had granulomatous diseases, 4 percent had cytomegalovirus, and 3 percent had group A beta-hemolytic Streptococcus. Remaining causes each accounted for less than 1 percent of cases. Among the 126 children with malignancies, 46 percent were not specified, 27 percent had non-Hodgkin lymphoma, 21 percent had Hodgkin lymphoma, and 2.4 percent had Langerhans cell histiocytosis.

GENERAL CLASSIFICATION — Lymphadenopathy can be caused by a vast array of diseases (table 1A-B and table 2) and drugs (table 3) [10,11]. Some presentations suggest a specific disease process, whereas a few diseases present predominantly with lymphadenopathy.

It is clinically useful to classify the causes of lymphadenopathy according to whether the lymphadenopathy is localized (in only one region, such as the neck or axilla) (table 2) or generalized (occurring in more than one noncontiguous region) (table 1A-B) [11].

Conditions that can mimic lymphadenopathy are discussed below. (See 'Mimics of lymphadenopathy' below.)

LOCALIZED LYMPHADENOPATHY — Localized lymphadenopathy is present in only one region, such as the neck or axilla. It is usually caused by an infection (table 2).

Selected causes of localized lymphadenopathy are discussed below. The evaluation and management of unexplained nonsupraclavicular localized lymphadenopathy are discussed separately. (See "Peripheral lymphadenopathy in children: Evaluation and diagnostic approach", section on 'Localized adenopathy'.)

Cervical — The anterior cervical lymph nodes are enlarged in a variety of infections of the head and neck and in systemic infections such as toxoplasmosis, Epstein-Barr virus, or cytomegalovirus infection. Only one-quarter of patients with enlarged cervical nodes have another serious disease, which most often is mycobacterial. Upper posterior cervical lymphadenopathy rarely is associated with significant diseases in children [10,11].

In considering the causes of cervical lymphadenopathy, it is helpful to distinguish between acute (develops over a few days) and subacute/chronic (develops over weeks to months) lymphadenopathy and whether the adenopathy is unilateral or bilateral. (See "Cervical lymphadenitis in children: Etiology and clinical manifestations".)

Inflamed cervical nodes that develop over a few days and progress to fluctuation, especially in children, typically are caused by staphylococcal (picture 1) and streptococcal infection [12]. Acute inflamed cervical nodes usually are unilateral. The source of infection may be unapparent even after careful examination. Treatment typically begins first with a course of antibiotics, but incision and drainage may be indicated. Antimicrobial treatment of cervical lymphadenitis is discussed separately. (See "Cervical lymphadenitis in children: Diagnostic approach and initial management", section on 'Initial laboratory evaluation and management'.)

Fluctuant cervical nodes that develop over weeks to months without significant inflammation or tenderness suggest infection with M. tuberculosis, atypical mycobacteria, or Bartonella henselae, the agent of cat scratch disease. Cat scratch disease is discussed separately. (See "Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease".)

Mycobacterial infections can present with lymphadenopathy alone, especially in the neck (scrofula). M. avium complex and M. scrofulaceum account for most cases in children [13,14]. Nodes typically are nontender, enlarge over weeks to months without prominent systemic symptoms, and can progress to matting and fluctuation (picture 2). (See "Nontuberculous mycobacterial lymphadenitis in children", section on 'Clinical features'.)

Hard nodes, often associated with cancer in adults, are found infrequently in children. The nodes involved with Hodgkin disease are rubbery and difficult to differentiate from hyperplastic nodes or nodes caused by granulomatous disease. (See "Overview of Hodgkin lymphoma in children and adolescents".)

Supraclavicular — Supraclavicular (or lower cervical) (figure 1) lymphadenopathy is associated with a high risk of malignancy (up to 75 percent) in children [7,11]. Right supraclavicular adenopathy is associated with cancer of the mediastinal lymph nodes. Left supraclavicular adenopathy ("Virchow's node") suggests intra-abdominal malignancy, most often lymphoma or metastatic disease (eg, neuroblastoma) [15].

Axillary — The axillary nodes receive drainage from the arm, thoracic wall, and breast. Infections, including cat scratch disease, are common causes of axillary lymphadenopathy. In one series of 31 children who underwent axillary node biopsies, 11 (35 percent) had reactive hyperplasia and five (16 percent) had cat scratch disease [3]. (See "Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease".)

Inguinal — Inguinal lymphadenopathy in children usually is not associated with a specific cause unless the nodes are very large (>3 cm). The inguinal lymph nodes drain the lower abdomen (including the umbilicus), genitalia (penis, scrotum, vulva), perineum, leg, and buttocks (table 2) [16,17].

Epitrochlear — Palpable epitrochlear nodes (figure 2) are often pathologic in children. However, many biopsied nodes show only hyperplasia if they are associated with cuts or abrasions and there are no other signs suggestive of malignancy. The differential diagnosis for epitrochlear lymphadenopathy includes infections of the forearm or hand, leukemia, lymphoma, and atypical mycobacterial infections. (See "Overview of the clinical presentation and diagnosis of acute lymphoblastic leukemia/lymphoma in children".)

GENERALIZED LYMPHADENOPATHY — Generalized lymphadenopathy is present in two or more noncontiguous regions. It may be a feature of numerous systemic diseases, many of which are recognized by other clinical findings (table 1A-B). Several of these diseases are discussed below.

Systemic infection — Systemic bacterial or viral illnesses are the most common causes of generalized adenopathy [14]. Common viral causes of generalized lymphadenopathy include Epstein-Barr virus or cytomegalovirus mononucleosis, rubella, and measles (in parts of the world where rubella and measles are endemic).

Mononucleosis — Classic infectious mononucleosis is characterized by the triad of moderate to high fever, pharyngitis, and lymphadenopathy. A characteristic distribution of lymph node involvement occurs; typically it is symmetric and involves the posterior cervical more than the anterior cervical chain. The posterior cervical nodes are deep to the sternocleidomastoid muscles (figure 1). Lymphadenopathy also may be present in the axillary and inguinal areas, which helps to distinguish infectious mononucleosis from other causes of pharyngitis. The lymph nodes are kidney-shaped and may be large. Lymphadenopathy peaks in the first week and then gradually subsides over two to three weeks. (See "Infectious mononucleosis".)

HIV — Lymphadenopathy is common in primary human immunodeficiency virus (HIV) infection. Nontender adenopathy primarily involving the axillary, cervical, and occipital nodes develops in the majority of individuals during the second week of acute symptomatic HIV infection, concomitant with the emergence of a specific immune response to HIV [14]. The nodes decrease in size after the acute presentation, but a modest degree of adenopathy tends to persist. (See "Pediatric HIV infection: Classification, clinical manifestations, and outcome", section on 'Clinical manifestations'.)

Miliary tuberculosis — Miliary tuberculosis is an important consideration in patients with generalized lymphadenopathy. Miliary tuberculosis can be mistaken for malignancy. (See "Clinical manifestations, diagnosis, and treatment of miliary tuberculosis" and "Epidemiology and pathology of miliary and extrapulmonary tuberculosis".)

Systemic lupus erythematosus — Enlargement of lymph nodes occurs in approximately 50 percent of patients with systemic lupus erythematosus (SLE). The nodes typically are soft; nontender; discrete; varying in size from 0.5 to several centimeters; and usually detected in the cervical, axillary, and inguinal areas. Lymphadenopathy is noted more frequently at the onset of disease or in association with an exacerbation. Lymph node enlargement also can be caused by infection or a lymphoproliferative disease in SLE; when infections are present, the enlarged nodes are more likely to be tender. (See "Childhood-onset systemic lupus erythematosus (SLE): Clinical manifestations and diagnosis", section on 'Hematologic'.)

Medications — Numerous medications may cause serum sickness that is characterized by fever, arthralgias, rash, and generalized lymphadenopathy (table 2). Phenytoin can cause generalized lymphadenopathy in the absence of a serum sickness reaction. (See "Serum sickness and serum sickness-like reactions" and "Antiseizure medications: Mechanism of action, pharmacology, and adverse effects", section on 'Phenytoin and fosphenytoin' and "Drug eruptions", section on 'Drug reaction with eosinophilia and systemic symptoms'.)

UNCOMMON BUT IMPORTANT CAUSES — Lymphadenopathy is a central feature of numerous less common systemic diseases that are important to consider because they are life-threatening or require specific treatment (table 1A-B and table 2).

Malignancy — Neoplastic causes of lymphadenopathy include Hodgkin disease, non-Hodgkin lymphoma, neuroblastoma, acute lymphocytic leukemia, acute myeloid leukemia, and rhabdomyosarcoma.

The prevalence of malignancy among patients seen in the primary care setting is relatively low [4,5]. In contrast, the prevalence of malignancy in lymph node biopsies performed in pediatric referral centers ranges from 13 to 27 percent [3,6,7]. Fever, duration of adenopathy, tenderness, bilaterality, skin rashes, and splenomegaly are not particularly helpful in discriminating between malignancy and other etiologies [7]. However, a higher incidence of cancer is expected in patients with certain clinical characteristics (table 4). We recommend immediate biopsy or diagnostic evaluation for serious underlying cause for patients who have these findings. Additional indications for lymph node biopsy are discussed separately. (See "Peripheral lymphadenopathy in children: Evaluation and diagnostic approach", section on 'Lymph node biopsy'.)

Kawasaki disease — Kawasaki disease is the most frequent cause of childhood vasculitis. This syndrome is associated with fever, cervical lymphadenopathy, and a variety of other manifestations, including conjunctivitis, mucositis, rash, and coronary artery aneurysms (table 5). (See "Kawasaki disease: Clinical features and diagnosis".)

COVID-19 multisystem inflammatory syndrome in children — Children with multisystem inflammatory syndrome in children (MIS-C) may present with cervical lymphadenopathy in addition to the more prevalent Kawasaki-disease-like features of fever, rash, mucous membrane involvement, and conjunctival injection. (See "COVID-19: Multisystem inflammatory syndrome in children (MIS-C) clinical features, evaluation, and diagnosis", section on 'Presenting symptoms'.)

Tularemia — Patients with tularemia typically present with fever and a single erythematous papuloulcerative lesion with a central eschar (picture 3) that is accompanied by tender regional lymphadenopathy (picture 4). (See "Tularemia: Clinical manifestations, diagnosis, treatment, and prevention", section on 'Clinical manifestations'.)

The majority of cases in the United States occur in the central United States (eg, Arkansas, Missouri, Kansas, Nebraska, and Oklahoma) (figure 3). (See "Tularemia: Microbiology, epidemiology, and pathogenesis", section on 'Geographic distribution'.)

Sources of infections in humans include vectors (eg, ticks, biting flies, and mosquitoes), handling of infected animals (rodents and rabbits), ingestion of inadequately cooked meat, drinking contaminated water, cat scratches or bites, or splashing infected material into the eye or rubbing eyes with contaminated fingers. (See "Tularemia: Microbiology, epidemiology, and pathogenesis", section on 'Routes of transmission'.)

Langerhans cell histiocytosis — Langerhans cell histiocytosis (LCH) may present with unilateral or bilateral cervical lymph nodes. Additional clinical manifestations of LCH may include lytic bone lesions, skin lesions, and hepatosplenomegaly. (See "Clinical manifestations, pathologic features, and diagnosis of Langerhans cell histiocytosis".)

Sometimes there is massive enlargement similar to those seen in Rosai-Dorfman disease. (See 'Rosai-Dorfman disease' below.)

Hemophagocytic lymphohistiocytosis — Hemophagocytic lymphohistiocytosis (HLH) patients have diffuse adenopathy in one-third of cases. Additional clinical manifestations of HLH may include fever, hepatosplenomegaly, neurologic symptoms, and skin lesions. (See "Clinical features and diagnosis of hemophagocytic lymphohistiocytosis", section on 'Clinical features'.)

Chronic granulomatous disease — Chronic granulomatous disease encompasses a heterogeneous group of disorders characterized by genetic defects in the ability of phagocytes to generate reactive oxygen intermediates from molecular oxygen. These defects manifest primarily as an immunodeficiency resulting in frequent, severe infections, including pneumonia, abscesses, suppurative adenitis, osteomyelitis, bacteremia/fungemia, and superficial skin infections (cellulitis/impetigo). (See "Chronic granulomatous disease: Pathogenesis, clinical manifestations, and diagnosis", section on 'Clinical manifestations'.)

Castleman disease — Multicentric Castleman disease is an uncommon lymphoproliferative disorder characterized by massive lymphadenopathy and systemic features such as fever, hepatomegaly, splenomegaly, and polyclonal hypergammaglobulinemia. Anemia is a common associated finding. (See "HHV-8/KSHV-associated multicentric Castleman disease".)

Unicentric Castleman disease affects only one lymph node and is rarely associated with systemic features. (See "Unicentric Castleman disease".)

Autoimmune lymphoproliferative disease — Patients with autoimmune lymphoproliferative disease (ALPS), also known as the Canale-Smith syndrome or autoimmunity/lymphoproliferation syndrome, usually present in the first year of life with massive cervical adenopathy that may obscure the angle of the jaw [18]. Splenomegaly also can occur. Frequent associations with autoimmune diseases, including hemolytic anemia, neutropenia, immune thrombocytopenia, glomerulonephritis, and Guillain-Barré syndrome, have been reported. The syndrome appears to be caused by a defect in lymphocyte apoptosis (programmed cell death). (See "Autoimmune lymphoproliferative syndrome (ALPS): Epidemiology and pathogenesis" and "Autoimmune lymphoproliferative syndrome (ALPS): Clinical features and diagnosis" and "Autoimmune lymphoproliferative syndrome (ALPS): Management and prognosis".)

Rosai-Dorfman disease — Rosai-Dorfman disease (also known as Rosai-Dorfman-Destombes disease and sinus histiocytosis with massive lymphadenopathy) is a rare non-Langerhans cell histiocytosis [19]. It often presents with markedly enlarged, nontender cervical adenopathy of massive proportions, similar to ALPS [20-24]. However, other nodal sites, including the mediastinum, retroperitoneal, axillary, and inguinal sites, also may be involved. Other manifestations include involvement of the nasal cavity, salivary gland tissue and other regions of the head and neck, lytic bone lesions, pulmonary nodules, or rash [25]. Patients often are febrile when massive lymphadenopathy is present. Laboratory evaluations show leukocytosis, polyclonal hypergammaglobulinemia, a hypochromic or normocytic anemia, and elevated ESR. Treatment is variable depending upon involvement of other nodal areas. Clofarabine has been especially effective for patients with bone and orbital involvement [26]. Spontaneous resolution may be observed but can take many months if not years [24]. International consensus guidelines for the diagnosis and management of Rosai-Dorfman disease provide guidelines for evaluation and treatment [19].

Kikuchi disease — Kikuchi disease is a rare, benign condition of unknown cause usually characterized by cervical lymphadenopathy (although it may be more generalized) and fever. It is discussed in detail separately. (See "Kikuchi disease".)

Kimura disease — Kimura disease, another rare cause of cervical lymphadenopathy, is characterized by a triad of painless subcutaneous masses in the head and neck with lymphadenopathy, blood and tissue eosinophilia, and markedly increased serum immunoglobulin E [27]. (See "Angiolymphoid hyperplasia with eosinophilia and Kimura disease", section on 'Kimura disease'.)

Inflammatory pseudotumor — Inflammatory pseudotumor of lymph nodes is a syndrome of lymphadenopathy in one or more node groups, often with systemic symptoms. Nodes show a fibrosing and inflammatory process [28].

Sarcoidosis — Children with sarcoidosis may present with impressive cervical adenopathy, similar to ALPS or Rosai-Dorfman disease patients. Lymphadenopathy is present in 50 percent of patients with sarcoidosis, who often have weight loss, cough, fatigue, lethargy, bone and joint pain, anorexia, and headache [29]. (See "Clinical manifestations and diagnosis of sarcoidosis" and "Overview of extrapulmonary manifestations of sarcoidosis".)

MIMICS OF LYMPHADENOPATHY — Conditions that can mimic an enlarged lymph node are listed below [16,30-32]. In most cases, these conditions can be differentiated from lymphadenopathy by the history and examination.

Infection or stones in any of the salivary glands (see "Mumps" and "Salivary gland stones")

Congenital anomalies: branchial cleft cyst, cystic hygroma (picture 5), thyroglossal duct cyst (see "Vascular lesions in the newborn", section on 'Macrocystic lymphatic malformation (cystic hygroma)' and "Thyroglossal duct cyst, thyroglossal duct cyst cancer, and ectopic thyroid")

Thyroid nodule (see "Thyroid nodules and cancer in children")

Soft-tissue swelling from trauma or an insect bite or sting

Hematoma

Inguinal hernia (see "Inguinal hernia in children" and "Evaluation of inguinal swelling in children", section on 'Causes of inguinal swelling')

Undescended testicle (see "Undescended testes (cryptorchidism) in children: Clinical features and evaluation", section on 'Clinical features')

Hemangioma, lymphangioma (see "Infantile hemangiomas: Epidemiology, pathogenesis, clinical features, and complications", section on 'Clinical presentation')

Lipoma

Dermoid (see "Skin nodules in newborns and infants", section on 'Dermoid cysts and sinuses')

Rheumatoid nodules (see "Rheumatoid nodules")

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient education" and the keyword[s] of interest.)

Basics topic (see "Patient education: Swollen neck nodes in children (The Basics)")

SUMMARY

Anatomy and definitions – Normal lymph nodes in most regions usually are less than 1 cm in their longest diameter; normal lymph nodes in the epitrochlear region usually are less than 0.5 cm, and normal lymph nodes in the inguinal region usually are less than 1.5 cm. (See 'Anatomy and definitions' above.)

General classification – Lymphadenopathy can be caused by a vast array of diseases (table 1A-B and table 2) and drugs (table 3). It is clinically useful to classify the causes of lymphadenopathy according to whether the lymphadenopathy is localized or generalized. (See 'General classification' above.)

Localized lymphadenopathy – Localized lymphadenopathy is present in only one region (table 2). (See 'Localized lymphadenopathy' above.)

Generalized lymphadenopathy – Generalized lymphadenopathy is present in two or more noncontiguous regions (table 1A-B). (See 'Generalized lymphadenopathy' above.)

Uncommon but important causes of lymphadenopathy – Uncommon but important causes of peripheral lymphadenopathy in children include (see 'Uncommon but important causes' above):

Malignancy

Malignancy should be considered in children with peripheral lymphadenopathy and worrisome features (table 4). Immediate lymph node biopsy is indicated in such children. Additional indications for biopsy are discussed separately. (See 'Malignancy' above and "Peripheral lymphadenopathy in children: Evaluation and diagnostic approach", section on 'Lymph node biopsy'.)

Kawasaki disease (table 5) (see "Kawasaki disease: Clinical features and diagnosis")

COVID-19 multisystem inflammatory syndrome in children (see "COVID-19: Multisystem inflammatory syndrome in children (MIS-C) clinical features, evaluation, and diagnosis", section on 'Presenting symptoms')

Tularemia (picture 4) (see "Tularemia: Clinical manifestations, diagnosis, treatment, and prevention", section on 'Clinical manifestations')

Langerhans cell histiocytosis (see "Clinical manifestations, pathologic features, and diagnosis of Langerhans cell histiocytosis")

Hemophagocytic lymphohistiocytosis (see "Clinical features and diagnosis of hemophagocytic lymphohistiocytosis", section on 'Clinical features')

Chronic granulomatous disease (see "Chronic granulomatous disease: Pathogenesis, clinical manifestations, and diagnosis", section on 'Clinical manifestations')

Castleman disease (see "HHV-8/KSHV-associated multicentric Castleman disease")

Autoimmune lymphoproliferative disease (see "Autoimmune lymphoproliferative syndrome (ALPS): Clinical features and diagnosis", section on 'Clinical manifestations of ALPS-FAS')

Rosai-Dorfman disease

Kikuchi disease (see "Kikuchi disease")

Kimura disease (see "Angiolymphoid hyperplasia with eosinophilia and Kimura disease", section on 'Kimura disease')

Inflammatory pseudotumor

Sarcoidosis (see "Clinical manifestations and diagnosis of sarcoidosis" and "Overview of extrapulmonary manifestations of sarcoidosis")

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Robert H Fletcher, MD, MSc, who contributed to an earlier version of this topic review.

  1. Jackson MA, Day JC. Lymphatic system and generalized lymphadenopathy. In: Principles and Practice of Pediatric Infectious Diseases, 5th ed, Long SS, Prober CG, Fischer M (Eds), Elsevier, Philadelphia 2018. p.128.
  2. Herzog LW. Prevalence of lymphadenopathy of the head and neck in infants and children. Clin Pediatr (Phila) 1983; 22:485.
  3. Knight PJ, Mulne AF, Vassy LE. When is lymph node biopsy indicated in children with enlarged peripheral nodes? Pediatrics 1982; 69:391.
  4. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician 1998; 58:1313.
  5. HEINRICH WA, JUDD ES Jr. A critical analysis of biopsy of lymph nodes. Proc Staff Meet Mayo Clin 1948; 23:465.
  6. Lake AM, Oski FA. Peripheral lymphadenopathy in childhood. Ten-year experience with excisional biopsy. Am J Dis Child 1978; 132:357.
  7. Soldes OS, Younger JG, Hirschl RB. Predictors of malignancy in childhood peripheral lymphadenopathy. J Pediatr Surg 1999; 34:1447.
  8. Celenk F, Gulsen S, Baysal E, et al. Predictive factors for malignancy in patients with persistent cervical lymphadenopathy. Eur Arch Otorhinolaryngol 2016; 273:251.
  9. Deosthali A, Donches K, DelVecchio M, Aronoff S. Etiologies of Pediatric Cervical Lymphadenopathy: A Systematic Review of 2687 Subjects. Glob Pediatr Health 2019; 6:2333794X19865440.
  10. Barton LL, Feigin RD. Childhood cervical lymphadenitis: a reappraisal. J Pediatr 1974; 84:846.
  11. Williamson HA Jr. Lymphadenopathy in a family practice: a descriptive study of 249 cases. J Fam Pract 1985; 20:449.
  12. Lai KK, Stottmeier KD, Sherman IH, McCabe WR. Mycobacterial cervical lymphadenopathy. Relation of etiologic agents to age. JAMA 1984; 251:1286.
  13. Spark RP, Fried ML, Bean CK, et al. Nontuberculous mycobacterial adenitis of childhood. The ten-year experience at a community hospital. Am J Dis Child 1988; 142:106.
  14. Gaines H, von Sydow M, Pehrson PO, Lundbegh P. Clinical picture of primary HIV infection presenting as a glandular-fever-like illness. BMJ 1988; 297:1363.
  15. Abramson SJ, Berdon WE, Stolar C, et al. Stage IVN neuroblastoma: MRI diagnosis of left supraclavicular "Virchow's" nodal spread. Pediatr Radiol 1996; 26:717.
  16. Hamilton W, Pascoe J, John J, et al. Diagnosing groin lumps. BMJ 2021; 372:n578.
  17. Yatabe R, Iio K, Uda K, Hataya H. Acute Inguinal Bacterial Lymphadenitis in Infants Younger Than 1 Year of Age. Pediatr Infect Dis J 2021; 40:e450.
  18. Sneller MC, Wang J, Dale JK, et al. Clincal, immunologic, and genetic features of an autoimmune lymphoproliferative syndrome associated with abnormal lymphocyte apoptosis. Blood 1997; 89:1341.
  19. Abla O, Jacobsen E, Picarsic J, et al. Consensus recommendations for the diagnosis and clinical management of Rosai-Dorfman-Destombes disease. Blood 2018; 131:2877.
  20. McAlister WH, Herman T, Dehner LP. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). Pediatr Radiol 1990; 20:425.
  21. Horneff G, Jürgens H, Hort W, et al. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): response to methotrexate and mercaptopurine. Med Pediatr Oncol 1996; 27:187.
  22. Pulsoni A, Anghel G, Falcucci P, et al. Treatment of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of a case and literature review. Am J Hematol 2002; 69:67.
  23. La Barge DV 3rd, Salzman KL, Harnsberger HR, et al. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): imaging manifestations in the head and neck. AJR Am J Roentgenol 2008; 191:W299.
  24. Foucar E, Rosai J, Dorfman R. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): review of the entity. Semin Diagn Pathol 1990; 7:19.
  25. Raslan OA, Schellingerhout D, Fuller GN, Ketonen LM. Rosai-Dorfman disease in neuroradiology: imaging findings in a series of 10 patients. AJR Am J Roentgenol 2011; 196:W187.
  26. Simko SJ, Tran HD, Jones J, et al. Clofarabine salvage therapy in refractory multifocal histiocytic disorders, including Langerhans cell histiocytosis, juvenile xanthogranuloma and Rosai-Dorfman disease. Pediatr Blood Cancer 2014; 61:479.
  27. Mrówka-Kata K, Kata D, Kyrcz-Krzemień S, Helbig G. Kikuchi-Fujimoto and Kimura diseases: the selected, rare causes of neck lymphadenopathy. Eur Arch Otorhinolaryngol 2010; 267:5.
  28. Moran CA, Suster S, Abbondanzo SL. Inflammatory pseudotumor of lymph nodes: a study of 25 cases with emphasis on morphological heterogeneity. Hum Pathol 1997; 28:332.
  29. Pattishall EN, Strope GL, Spinola SM, Denny FW. Childhood sarcoidosis. J Pediatr 1986; 108:169.
  30. Torsiglieri AJ Jr, Tom LW, Ross AJ 3rd, et al. Pediatric neck masses: guidelines for evaluation. Int J Pediatr Otorhinolaryngol 1988; 16:199.
  31. Margileth AM. Sorting out the causes of lymphadenopathy. Contemp Pediatr 1995; 12:23.
  32. Yaris N, Cakir M, Sözen E, Cobanoglu U. Analysis of children with peripheral lymphadenopathy. Clin Pediatr (Phila) 2006; 45:544.
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References

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