Definition: Lymphadenopathy refers to persistent enlarged lymph glands.
Common causes of enlarged lymph glands include:
- acute bacterial infections and viral infections such as EBV and HIV
- chronic infections such as TB or toxoplasma
- immunological disorders including rheumatoid arthritis, systemic lupus and sarcoidosis
- chronic skin conditions such as chronic eczema
- drug reactions especially carbamazepine and some anti-psychotic medication
- haematological malignancies such as lymphoma or metastatic carcinoma.
Isolated Lymphadenopathy following COVID-19 vaccination.
If a patient presents with lymphadenopathy localised to a recent COVID-19 vaccination site, please consider asking the patient to self-monitor and report back once they are 4 weeks post-vaccination if it persists.
C.M & L.W 31-07-23
Who to refer:
- Size significant lymphadenopathy, persistent for 6 weeks or more:
- Nodes at an unusual site
- Lymph nodes that are increasing in size
- Nodes > 2cms
- Widespread nodal enlargement and / or splenomegaly.
- Size significant lymphadenopathy with significant systemic symptomsdrenching night sweats, weight loss, fever, alcohol-induced pain.
Prior to referral, please undertake the investigations listed under Primary Care Management.
Who not to refer:
‘Pea-sized’ nodes, 1cm or less in diameter, in individuals with no significant systemic symptoms. This is a common clinical finding especially in slim young adults and in most cases is not abnormal.
How to refer:
Please refer via SCI Gateway to haematology at the WGH or St Johns.
Patients with clinically significant isolated neck nodes should be referred directly to ENT neck lump clinic for consideration of biopsy.
Patients with clinically significant isolated axillary nodes should be referred directly to the Breast Clinic for further management.
Primary care investigations
- FBC, ESR
- Blood film
- Viral serology for EBV (IgM), CMV, HIV
- Serology for Toxoplasma
- Quantitative immunoglobulins + serum electrophoresis
