Clin- Lymphadenopathy & Splenomegaly Pales Flashcards
Lymph node contents
Macrophages
Dendritic cells
B lymphocytes
T lymphocytes
lymph node functions
Antigen processing
Antigen presentation
Antigen recognition
Effector B and T cell proliferation are part of normal immune response
localized bacterial causes of lymphadenopathy
Strep pharyngitis, skin infection, tularemia, plague, cat scratch disease, diphtheria, chancroid, rat bite fever
generalized bacterial causes of lymphadenopathy
Brucellosis, leptospirosis, lymphogranuloma venereum, typhoid fever
viral causes of lymphadenopathy
HIV, EBV, HSV, CMV, mumps, measles, rubella, Hep B, Dengue fever
mycobacterial causes of lymphadenopathy
Mycobacterium tuberculosis, atypical mycobacteria
fungal causes of lymphadenopathy
Histoplasmosis ,coccidiodomycosis, cryptococcosis
protozoal causes of lymphadenopathy
Toxoplasmosis, leishmaniasis
spirochetal causes of lymphadenopathy
Secondary syphilis, Lyme disease
lymphoproliferative causes of lymphadenopathy
Angioblastic lymphadenopathy with dysproteinemia, autonimmune lymphoproliferative disease, Rosai-Dorfman disease, Hemophagocytic lymphohistiocytosis
immunologic causes of lymphadenopathy
Serum sickness, drug reactions (i.e. phenytoin)
endocrine causes of lymphadenopathy
Hypothyroidism, Addison’s disease
miscellaneous causes of lymphadenopathy
Sarcoidosis, Lipid storage diseases, Amyloidosis, Histiocytosis, Chronic granulomatous disease, Kikuchi’s disease, Kawasaki disease, Inflammatory Pseudotumor, SLE, RA, Still’s disease, Dermatomyositis, Churg-Strauss Syndrome
anterior cervical lymphadenopathy
Localized: Strep or staph infection, Rubella, Dental
Systemic: EBV, CMV, Toxoplasmosis
posterior cervical lymphadenopathy
EBV, TB, Lymphoma, Head/neck malignancy
supraclavicular lymphadenopathy
Right: CA of medastinum, lungs, or esophagus
Left (Virchow’s node): Abdominal malignancy (stomach, gall bladder, pancreas, kidneys, testicles, ovaries, prostate)
axillary lymphadenopathy
Infectious: Cat scratch disease, Cellulitis
Cancer: Breast, Other metastases
Silicone breast implants (may cause both supraclavicular and axillary lymphadenopathy)
epitrochlear lymphadenopathy
Infections of forearm or hand Lymphoma Sarcoidosis Tularemia Secondary syphilis
inguinal lymphadenopathy
Lower extremity infection
STD
Cancer: skin of LE or trunk, cervix, ovary, vulva, rectum, anus, penis
mediastinal lymphadenopathy
Infectious: TB, Fungal infection, Anthrax
Neoplastic: Lymphoma, Lung CA, Germ cell tumor
Other: Sarcoidosis
retroperitoneal lymphadenopathy
Infectious: TB
Neoplastic: Lymphoma, Testicular CA, Kidney CA, Upper GI malignancy
Other: Sarcoidosis
mesenteric lymphadenopathy
Infectious: Appendicitis, Cholecystitis, Diverticulitis, Whipple’s disease
Neoplastic: Lymphoma, GI cancer
Other: IBD, Panniculitis
generalized lymphadenopathy with HIV
Non-tender
Primarily axillary, cervical, occipital nodes
Usually develops during 2nd week of acute symptomatic HIV
Decrease in size, but modest degree of adenopathy persists
generalized lymphadenopathy with mycobacteria
Can present with lymphadenopathy alone, especially in neck (scrofula)
M. tuberculosis in adults
Atypical mycobacteria in kids
Non-tender
Enlarge over weeks to months without prominent systems symptoms
Can progress to matting and fluctuation
generalized lymphadenopathy with infectious mononucleosis
Triad: fever, pharyngitis, lymphadenopathy
Symmetric enlargement
Posterior > anterior cervical nodes
Axillary and inguinal are common too (as opposed to other causes of pharyngitis)
Lymphadenopathy peaks in 1st week and then gradually subsides over 2-3 weeks
generalized lymphadenopathy with SLE
Seen in ~50% of patients
Soft, non-tender
Cervical, axillary, inguinal nodes
Usually develops at onset of disease, or in association with exacerbation
generalized lymphadenopathy with medications
Drugs causing serum sickness (fever, arthralgias, rash)
Phenytoin can cause generalized lymphadenopathy in absence of serum sickness reaction
Other drugs that cause lymphadenopathy: allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, PCN, primidone, pyrimethamine, quinidine, sulfonamides, sulindac
Cattleman’s syndrome
Uncommon lymphoproliferative disorder
Massive lymphadenopathy with fever, hepatosplenomegaly polyclonal hypergammaglobulinemia, amyloidosis
Other causes of mono-like disease
CMV, HHV6, HIV, Adenovirus, HSV, S. pyogenes, Toxoplasma gondii
Kikuchi’s disease
Rare, benign condition of unknown cause
Affects young women
Cervical lymphadenopathy only or generalized
Fever
Kawasaki disease
Childhood vasculitis
Cervical lymphadenopathy with fever, conjunctivitis, mucositis (strawberry tongue), rash, coronary artery aneurysms
angioimmunoblastic T cell lymphoma
Systemic disease
Generalized lymphadenopathy with fever, hepatosplenomegaly, hemolytic anemia, polyclonal hypergammaglobulinemia
inflammatory pseudotumor
Syndrome of lymphadenopathy in 1+ node groups
Systemic symptoms
Nodes usually show a fibrosing and inflammatory process
amyloidosis
Systemic disease with deposition of amyloid protein.
Most often will have amyloid deposition in other organs, but occasionally can be deposited only in nodes
Kimura disease
Inflammatory condition of subQ tissue and lymph nodes of head/neck
Associated with elevated serum IgE and eosinophilia.
firm, rubbery lymphadenopathy
lymphomas, chronic leukemia
causes of splenomegaly
congestive malignancy infiltrative infectious inflammation hematologic
congestive causes of splenomegaly
Cirrhosis
CHF
Thrombosis of portal, hepatic, or splenic veins
malignant causes of splenomegaly
Hematologic malignancies (lymphoma, acute and chronic leukemias, polycythemia vera, multiple myeloma, essential thrombocythemia) Primary splenic tumors Non-hematologic metastatic solid tumors
infiltrative (non-malignant) causes of splenomegaly
Gaucher's disease Niemann-Pick disease Amyloid Glycogen storage disease Langerhans cell histiocytosis Hemophagocytic lymphohistiocytosis
infectious causes of splenomegaly
Viral (hepatitis, infectious mononucleosis, CMV)
Bacterial (salmonella, brucella, TB)
Parasitic (malaria, schistosomiasis, toxoplasmosis, leishmaniasis)
Infective endocarditis (embolic)
Fungal
inflammatory causes of splenomegaly
Sarcoid
Serum sickness
SLE
RA (Felty syndrome)
hematologic causes of splenomegaly
Acute and chronic hemolytic anemias, all etiologies
Sickle cell disease (children)
Following use of recombinant human granulocyte colony-stimulating factor
Myelofibrosis
Chronic ETOH or hepatitis & ascites
splenomegaly secondary to cirrhosis and portal HTN
Young adult with fatigue, fever, sore throat, splenomegaly
infectious mononucleosis or other viral infection
Older adult c/o post-bath pruritis with ruddy complexion and splenomegaly
polycythemia vera
