Makindo Medical Notes

An important list to know. Mostly infective and autoimmune processes. The list is by no means complete. Generalised lymphadenopathy refers to the enlargement of lymph nodes in multiple regions of the body. It is often a sign of systemic disease and can result from infections, autoimmune disorders, malignancies, and other conditions.

Causes of Generalised Lymphadenopathy

• Infections:
  • Viral infections: Epstein-Barr virus (EBV), cytomegalovirus (CMV), HIV, hepatitis B and C, rubella, and measles.
  • Bacterial infections: Tuberculosis, syphilis, brucellosis, and cat scratch disease.
  • Parasitic infections: Toxoplasmosis, leishmaniasis.
  • Fungal infections: Histoplasmosis, coccidioidomycosis.
• Autoimmune Disorders:
  • Systemic lupus erythematosus (SLE)
  • Rheumatoid arthritis
  • Sarcoidosis
• Malignancies:
  • Lymphomas: Hodgkin and non-Hodgkin lymphoma
  • Leukaemias: Chronic lymphocytic leukaemia (CLL), acute lymphoblastic leukaemia (ALL)
  • Metastatic cancer
• Other Causes:
  • Drug reactions: Phenytoin, allopurinol, certain antibiotics.
  • Primary immunodeficiency disorders
  • Castleman disease

Clinical Presentation

• History:
  • Duration and progression of lymph node enlargement
  • Associated symptoms: Fever, night sweats, weight loss, fatigue, rash, joint pain
  • Exposure history: Recent travel, animal contacts, high-risk behaviors
  • Medication history
• Physical Examination:
  • Palpation of lymph nodes: Size, consistency, tenderness, mobility, and location (cervical, axillary, inguinal, etc.)
  • Examination of other systems: Skin, respiratory, cardiovascular, abdominal, musculoskeletal, and neurological exams to identify associated signs of systemic disease

Diagnosis

• Laboratory Tests:
  • Complete blood count (CBC) with differential
  • Inflammatory markers: ESR, CRP
  • Serologic tests: HIV, EBV, CMV, hepatitis B and C, syphilis, and others as indicated
  • Autoimmune markers: ANA, rheumatoid factor, anti-dsDNA, and others as indicated
  • Blood cultures if infection is suspected
• Imaging Studies:
  • Chest X-ray or CT scan to assess thoracic lymphadenopathy
  • Ultrasound or CT scan of the abdomen and pelvis
  • PET scan for suspected malignancy
• Lymph Node Biopsy:
  • Excisional or core needle biopsy to obtain tissue for histopathological examination
  • Indicated if malignancy or specific infection is suspected

Management

• Treat Underlying Cause:
  • Antibiotics for bacterial infections
  • Antiviral therapy for viral infections (e.g., antiretroviral therapy for HIV)
  • Antifungal or antiparasitic treatment for specific infections
  • Immunosuppressive therapy for autoimmune disorders
  • Chemotherapy, radiation therapy, or targeted therapy for malignancies
• Supportive Care:
  • Pain management
  • Hydration and nutrition support
  • Monitoring for complications
• Follow-Up:
  • Regular monitoring of lymph node size and symptoms
  • Repeat imaging or biopsy if there is no improvement or if new symptoms develop

Prognosis

The prognosis of generalised lymphadenopathy depends on the underlying cause. Infections typically resolve with appropriate treatment, while autoimmune disorders may require long-term management. The prognosis for malignancies varies based on the type and stage of cancer.

Summary

Generalised lymphadenopathy involves the enlargement of lymph nodes in multiple regions and can result from various conditions, including infections, autoimmune disorders, malignancies, and other causes. Diagnosis involves a thorough history, physical examination, laboratory tests, imaging studies, and sometimes lymph node biopsy. Treatment focuses on addressing the underlying cause and providing supportive care. Prognosis depends on the etiology of the lymphadenopathy.