Clinical feature | Potential significance |
History | |
Onset, laterality, and duration | Helps to narrow etiology |
Constitutional symptoms (eg, weight loss, fatigue, malaise) | Malignancy, Kikuchi disease, Castleman disease, sarcoidosis |
Recurrent/chronic cough, hemoptysis | Tuberculosis |
Arthritis/arthralgia | Juvenile idiopathic arthritis, systemic lupus erythematosus |
Nasal, aural, or sinus obstruction without drainage | Rhabdomyosarcoma |
Immunizations status | Measles, mumps, rubella, diphtheria (if unimmunized); postvaccination lymphadenitis (if recently immunized, particularly with diphtheria-tetanus-pertussis, polio, or typhoid fever vaccine) |
Exposures | |
| Supports infectious etiology |
| Brucellosis, Mycobacterium bovis |
| Toxoplasmosis |
| Cats (cat scratch disease, Pasteurella multocida, toxoplasmosis); dogs (P. multocida) rabbits (tularemia); hamster (tularemia); goats (brucellosis); prairie dogs (plague) |
| Plague, tularemia |
| Medication-related |
| May need to consider less common causes (eg, tularemia, plague, tuberculosis) |
Examination | |
Lymph node qualities | |
| Suggestive of "reactive" lymphadenopathy |
| Suggestive of infection |
| May indicate malignancy |
Hepatosplenomegaly and involvement of noncervical nodes | Systemic infection (eg, EBV, CMV, HIV, histoplasmosis, tuberculosis, syphilis), juvenile idiopathic arthritis, Castleman disease |
Conjunctivitis | Cat scratch disease, tularemia, adenovirus, Kawasaki disease, measles |
Poor dental hygiene, periodontal disease, dental caries | Anaerobic infection |
Loose teeth | Langerhans cell histiocytosis |
Mouth sores/lesions | HSV, enterovirus, PFAPA, Kawasaki disease, Langerhans cell histiocytosis |
Pharyngitis | GAS, EBV, PFAPA, diphtheria |
Localized skin lesion | More common: Staphylococcus aureus, GAS, cat scratch disease, tularemia, HSV Less common: Nocardia, actinomycosis, sporotrichosis, plague, cutaneous diphtheria |
Generalized rash | Systemic viral illness (eg, roseola, EBV, measles, rubella, parvovirus B19), Kawasaki disease, juvenile idiopathic arthritis, systemic lupus erythematosus, Langerhans cell histiocytosis, hemophagocytic lymphohistiocytosis |
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