Lymph nodes not lymphoma
Inflammatory disorders (non-infectious)
Acute nonspecific lymphadenitis

Author: Jaya Balakrishna, M.D. (see Authors page)

Revised: 8 May 2017, last major update April 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Acute nonspecific lymphadenitis
Cite this page: Acute nonspecific lymphadenitis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/lymphnodesacutenonspecificlymphadenitis.html. Accessed May 22nd, 2017.
Definition / general
  • Acute inflammation of lymph nodes
Essential features
  • Enlarged and painful, tender lymph nodes
  • Microscopic examination, if performed, will show sinus dilatation followed by accumulation of neutrophils, vascular dilatation and edema of the capsule
Terminology
  • Acute nonspecific lymphadenitis, nontuberculous lymphadenitis
ICD-10 coding
  • L04
Epidemiology
  • Common, mostly affects children
Sites
  • Cervical lymph nodes are commonly affected
  • Acute nonspecific mesenteric lymphadenitis is also a relatively common in children
Pathophysiology
  • Acute inflammation of the involved lymph node / nodes due to an infectious or inflammatory etiology
Etiology
  • Most commonly due to viral infections
  • Most common bacterial causes are Staphylococcus aureus and beta hemolytic streptococcus
  • Inflammation of the draining sites or direct inflammation of the lymph nodes can be the cause
Clinical features
  • Enlarged painful / tender lymph nodes, redness of overlying skin, low grade fever, malaise
Diagnosis
  • Clinical examination, exclude specific causes
Laboratory
  • Depending on the cause, CBC may show leukocytosis with neutrophilia or lymphocytosis, elevated ESR and bacterial / viral confirmatory tests may be positive
Prognostic factors
  • Good prognosis
Treatment
  • Treat the underlying cause, supportive therapy
Gross description
  • Enlarged lymph node
  • If bacterial infection, there can be suppuration leading to necrosis and abscess formation
Microscopic (histologic) description
  • Biopsy is rarely performed
  • Microscopic examination, if performed, will show sinus dilatation followed by accumulation of neutrophils, vascular dilatation and edema of the capsule
  • If bacterial origin, suppurative inflammation is present
  • Necrotizing inflammation can be seen in bubonic plague and tularemia, Still’s disease and Kikuchi necrotizing lymphadenitis
Microscopic (histologic) images

Images hosted on other server:
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Acute lymphadenitis

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Foci of necrosis and acute inflammatory cells

Cytology description
  • Mixed small and large lymphocytes admixed with neutrophils
Positive stains
  • Varies by etiology
  • Gram stain highlights bacteria, if present
Differential diagnosis
Board review question #1
A 23 year old woman presents with tender right cervical lymph node enlargement. She also complains of low grade fever and feeling tired. On examination she is found to have three 4mm red papules on her right shoulder. On further enquiry she informs that she owns two cats. What is the best confirmatory test at this point?

A. Serology
B. PCR
C. Biopsy of the skin lesion
D. Biopsy of the lymph node
Board review answer #1
A. Serology

Serology for IgG and IgM antibodies for Bartonella Henslae is confirmatory for cat scratch disease. Biopsy is rarely indicated. If performed, a biopsy will show lymphoid hyperplasia, granuloma formation, stellate abscesses and vascular proliferation depending on the stage of the disease. PCR can be done on biopsy specimen to confirm the diagnosis