Lymphadenopathy and Fever
Jonathan P. Moorman
Generalized lymphadenopathy with associated fever is a symptom complex common to many different disease entities. Persistent generalized lymphadenopathy is defined as two or more extrainguinal sites lasting for 3 to 6 months with no other cause. Illnesses such as infection, autoimmune disorders, malignancy, and drug hypersensitivity may all present with fever and lymph node enlargement.
INFECTIOUS DISEASES
The range of infectious diseases that can cause generalized lymphadenopathy is extensive, and initial evaluation of the patient will require a detailed history. Clinical clues may be found in the symptoms, a system review to include epidemiology, and the social/occupational history.
Fungal diseases such as histoplasmosis and coccidioidomycosis may be suggested by exposure history and geographic setting. A history of contact with sheep or employment in a slaughterhouse or drinking unpasteurized milk suggests brucellosis should be considered. Contact with ticks or rodents suggests the possibility of tularemia. Contact with cats might be a clue to cat scratch disease or toxoplasmosis. The patient should be asked about exposure to tuberculosis or travel to areas where trypanosomal or leishmanial organisms are endemic. Table 71-1 lists infectious diseases that have been associated with generalized lymphadenopathy.
A detailed history of sexual activities and risk factors for AIDS needs to be obtained. HIV disease may present with lymphadenopathy in association with acute retroviral syndrome. Generalized lymphadenopathy may occur in HIV disease in association with non-Hodgkin lymphoma. Secondary syphilis and lymphogranuloma venereum can also cause fever and diffuse lymphadenopathy with or without HIV disease.
AUTOIMMUNE DISORDERS
In the evaluation of the patient with fever and lymphadenopathy, a history of joint pain, rash, other lupus clinical signs and symptoms, dry mouth, and dry eyes should be obtained.
Rheumatoid arthritis, systemic lupus erythematosus (SLE), and Sjögren syndrome are the most common autoimmune disorders to cause lymphadenopathy.
Lymphadenopathy is present in 75% of rheumatoid arthritis patients at some point in the illness. Enlarged nodes may or may not occur in association with inflamed joints, and fever is also common. Pathology will show reactive lymphoid hyperplasia.
Lymphadenopathy occurs in 25% to 70% of patients with SLE. Fever and lymphadenopathy can be the initial symptoms.
Sjögren syndrome will cause dry eyes and dry mouth with lymphocytic infiltration of salivary and lacrimal glands. Fever is less commonly associated with this syndrome.
Table 71-1 Infectious Causes of Generalized Lymphadenopathy | ||||||||||
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DRUG HYPERSENSITIVITY AND UNUSUAL SYSTEMIC DISEASES
Hypersensitivity reactions to drugs are an increasingly common cause of diffuse lymphadenopathy. Fever, rash, or eosinophilia may be part of the syndrome.
Phenytoin, carbamazepine, sulfa drugs, and other antibiotics are most commonly implicated, but many different drugs can produce this syndrome. Reactions occur within weeks to months of initiation of the medication. A wide range of pathology, from reactive hyperplasia to malignancy, may be seen.
Sarcoidosis is a systemic disease of unknown cause that usually affects middle-aged adults. The disease usually presents with bilateral hilar adenopathy, skin lesions, pulmonary infiltrates, and ocular symptoms. The liver, spleen, salivary glands, kidneys, and central nervous system also may be involved. Histology shows noncaseating epithelioid granulomas. Fever and generalized lymphadenopathy would be an unusual presentation.Related posts:
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