In this lecture, we’ll discuss cervical lymphadenitis and all its various causes. So, cervical
lymphadenitis is common in children. It’s an enlargement of lymph nodes in the anterior chain
of the neck. Happens usually between kids, in kids usually between the age of 1 and 5 and it’s
usually infectious but it can be caused by a number of other things. Sometimes it’s caused by
drainage of active organisms from infected mucous membranes of the mouth and throat. So this
bacteria are essentially carried to the lymph node where they then take over and infect and
cause a bacterial cervical lymphadenitis. So, understanding cervical lymphadenitis is important
but before we go there we need to think about what else could this be and understand the
differential diagnosis. Identifying cervical lymphadenitis as bacterial is usually best done by
taking a good history and doing a thorough exam. So let’s look at the key things to look for that
are other causes of cervical lymphadenopathy. So one example would be cancers. Specifically
lymphoma may present with multiple nodules, they tend to be firm and rubbery, they are matted
and immobile and they are non-tender. The patient may have a history of weight loss or other
signs of systemic disease. This is true for most of our cancerous causes of lymphadenopathy in
children. They tend to be multiple, firm, rubbery, fixed in position and non-tender. What about
viral disease? Viruses like Epstein-Barr virus and cytomegalovirus can cause profound lymphadenopathy
of the anterior cervical chain but even simple common cold viruses can do it like RSV, adeno,
influenza or parainfluenza. Usually, viral lymphadenopathy is bilateral, it’s not usually unilateral.
Usually there are multiple nodes, not just one predominant node. They usually have other
symptoms of runny nose, congestion, cough, other symptoms of the upper respiratory infection
and for mononucleosis they usually have a severe pharyngitis with purulent drainage, a spleen
or a big liver and spleen and they may have had multiple nodes not only at the neck but also in the
armpits and around the groin. So they are more of a disseminated disease that may well be EBV
or mono. So what about strep throat that usually comes with significant lymphadenopathy?
Again, this is usually a bilateral presentation, there are usually multiple nodes. This patient will
also have palatal petechiae as you can see here. It may be purulent much like EBV but the
palatal petechiae is classic. They will have a prominent sore throat and they will have a paucity
of runny nose and congestion. Large tonsils are likely in strep throat. Also, patients with some
systemic diseases can absolutely present with lymph nodes in the anterior cervical chain. For
example, in Kawasaki disease that’s one of our criteria for the disease. Also patients with JIA
or HIV may have it and then there’s this unusual condition which we see periodically in children
called periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis. It’s called PFAPA
for short. This is a recurrent fever syndrome but lymph nodes predominate in this disease.
Signs of these diseases are usually present other than lymphadenitis. So in Kawasaki they may
have a non-purulent conjunctivitis, swollen hands and feet or rash. In JIA, they will have
arthritis or in systemic disease they may have this salmon rash. In PFAPA, they have these
other things you see here with periodic fevers, aphthous ulcers of the mouth, a sore throat.
In HIV, they may have weight loss and other sequelae from acute HIV.