Infectious causes of subacute/chronic bilateral cervical lymphadenitis in children

Infection	Clinical features
Common causes
Epstein-Barr virus (EBV)*	Infectious mononucleosis (fever, exudative pharyngitis, hepatosplenomegaly); positive monospot or EBV serology
Cytomegalovirus (CMV)*	Mononucleosis-like illness; positive CMV serology
Uncommon causes
Human immunodeficiency virus (HIV)*	High-risk behavior (unprotected sexual contact, injection drug use, etc)
Toxoplasmosis*	Exposure to cat feces; ingestion of poorly cooked meat, soil, or contaminated food; posterior cervical involvement
Mycobacterium tuberculosis*	Birth in, travel to, or contact with a visitor from a region endemic for Mycobacterium tuberculosis; tuberculin skin test usually with ≥15 mm induration at 48 hours; positive interferon-gamma release assay
Mycobacterium bovis	Ingestion of unpasteurized dairy products; exposure to cattle
Syphilis*	High-risk sexual behavior
Rare causes
Brucellosis*	Travel to or living in endemic area; ingestion of unpasteurized dairy products
Histoplasmosis*	Associated skin lesions

* Often associated with generalized lymphadenopathy.

Graphic 97719 Version 4.0