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Noninfectious causes of cervical lymphadenopathy in children

Noninfectious causes of cervical lymphadenopathy in children
Condition Possible associated clinical features
Malignancy
Lymphoma or leukemia Persistent, or progressive, nontender cervical or generalized lymphadenopathy; constitutional symptoms (eg, fever, weight loss, fatigue)
Neuroblastoma Constitutional symptoms (fever, weight loss); abdominal mass; GI symptoms; proptosis; periorbital ecchymoses; Horner syndrome; opsoclonus myoclonus ataxia; palpable subcutaneous nodules; bone pain; hypertension; unilateral nasal obstruction
Rhabdomyosarcoma Localized, painless, enlarging mass; proptosis; ophthalmoplegia; nasal, aural, or sinus obstruction (without drainage)
Thyroid cancer History of external radiation to the head and neck; hoarseness; dysphagia; medullary thyroid cancer may be associated with multiple endocrine neoplasias
Collagen vascular disease
Juvenile idiopathic arthritis Arthritis/arthralgia; fever; rash; other systemic involvement (eg, hepatosplenomegaly, pericarditis, etc)
Systemic lupus erythematosus Arthritis/arthralgia; hematologic abnormalities (anemia, leukopenia, lymphopenia, thrombocytopenia); malar rash; oral ulcers; fever; renal disease
Drugs
Phenytoin Seizure disorder
Carbamazepine Seizure disorder
Miscellaneous
Kawasaki disease Fever; rash; nonexudative conjunctivitis; enanthem; swelling of hands and feet
MIS-C (postinfectious) Presentation may be similar to incomplete Kawasaki disease or toxic shock syndrome
PFAPA Recurrent fevers; aphthous stomatitis; pharyngitis; and adenitis
Kikuchi disease Fever; rash; systemic symptoms (fatigue, weight loss); leukopenia; anemia; usually occurs in young adult females
Langerhans cell histiocytosis Lytic bone lesions; rash (papular or eczematous); oral lesions (mass, gingivitis, ulcers, loose teeth); diabetes insipidus
Hemophagocytic lymphohistiocytosis Hepatomegaly; rash; neurologic findings (seizures, mental status changes); anemia; thrombocytopenia; most frequent at age <10 months, but may occur in older children
Castleman disease Lymph nodes may be >4 cm (1.6 inches); may have systemic symptoms (fever, night sweats, malaise); hepatosplenomegaly; anemia, thrombocytosis
Kimura disease Painless subcutaneous masses in head and neck; eosinophilia; increased IgE
Postvaccination Recent history of immunization (particularly diphtheria-tetanus-pertussis, polio, or typhoid fever vaccine)
Sarcoidosis Extensive enlargement of cervical nodes; facial eruption (flat-topped papules); weight loss; lethargy; fatigue, cough; bone lesions (eg, cystic or sclerotic focal lesions, osteopenia, osteoporosis)
GI: gastrointestinal; MIS-C: multisystem inflammatory syndrome in children; PFAPA: periodic fever with aphthous stomatitis, pharyngitis, and adenitis syndrome; IgE: immunoglobulin E.
Graphic 77911 Version 13.0

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