Swollen glands

Swollen Glands (Lymphadenopathy)

Introduction

The term “swollen glands” usually refers to enlarged lymph nodes (lymphadenopathy). Lymph nodes are small, bean-shaped structures of the immune system that filter lymphatic fluid and help fight infections. They are commonly felt in the neck, armpits, and groin.

Swollen glands may be localized (affecting one region) or generalized (involving multiple regions). Most cases are benign and due to infections, but persistent or unexplained lymphadenopathy may signal more serious conditions such as autoimmune disease, lymphoma, or metastatic cancer.

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Causes of Swollen Glands

1. Infectious Causes

• Viral infections:

  • Common cold (rhinovirus, adenovirus).

  • Influenza.

  • Infectious mononucleosis (Epstein–Barr virus, EBV).

  • Cytomegalovirus (CMV).

  • HIV.

• Bacterial infections:

  • Streptococcal or staphylococcal pharyngitis (strep throat, tonsillitis).

  • Tuberculosis (chronic lymphadenitis).

  • Cat-scratch disease (Bartonella henselae).

  • Syphilis.

• Parasitic: Toxoplasmosis.

• Fungal: Histoplasmosis, coccidioidomycosis (endemic mycoses).

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2. Inflammatory and Autoimmune Causes

• Rheumatoid arthritis.

• Systemic lupus erythematosus (SLE).

• Sarcoidosis.

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3. Malignancies

• Lymphomas (Hodgkin’s and Non-Hodgkin’s).

• Leukemia (chronic lymphocytic leukemia, acute leukemias).

• Metastatic cancers (breast, lung, head and neck, gastrointestinal, melanoma).

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4. Drug-Induced Lymphadenopathy

• Phenytoin.

• Allopurinol.

• Certain antibiotics (sulfonamides).

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Clinical Presentation

• Typical features: palpable lumps in neck, armpit, or groin.

• Painful, tender nodes → usually infection or inflammation.

• Hard, fixed, painless nodes → may suggest malignancy.

• Associated symptoms:

  • Fever, sore throat, cough (infectious).

  • Weight loss, night sweats, fever (“B symptoms” in lymphoma).

  • Generalized fatigue and malaise.

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Diagnostic Evaluation

History

• Recent infections (throat, ear, dental, skin).

• Travel and exposure history (TB, HIV risk factors).

• Systemic symptoms: fever, night sweats, weight loss.

• Medication history.

Examination

• Location: localized vs generalized.

• Size and consistency:

  • Soft, tender, mobile → usually benign/infectious.

  • Hard, fixed → malignancy.

• Other findings: splenomegaly, hepatomegaly, rash, joint swelling.

Investigations

• Blood tests:

  • Full blood count (infection, leukemia).

  • ESR/CRP (inflammation).

  • HIV, EBV, CMV serology.

• Imaging:

  • Ultrasound of lymph nodes (size, vascularity).

  • CT or MRI (if malignancy suspected).

• Definitive diagnosis:

  • Fine-needle aspiration (FNA).

  • Excisional biopsy (gold standard for lymphoma).

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Treatment

1. General Measures

• Treat underlying cause.

• Warm compresses for painful nodes.

• Analgesics and antipyretics:

  • Paracetamol (acetaminophen): 500–1000 mg every 6 hours as needed (max 4 g/day).

  • Ibuprofen: 200–400 mg every 6–8 hours (max 2400 mg/day).

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2. Infectious Causes

• Bacterial infections (streptococcal pharyngitis, skin infections)

  • Amoxicillin: 500 mg orally every 8 hours for 7–10 days.

  • Phenoxymethylpenicillin (Penicillin V): 500 mg orally every 6 hours for 10 days.

  • Clindamycin: 300 mg orally every 8 hours (if penicillin-allergic).

• Tuberculosis (lymph node TB)

  • Standard RIPE regimen (rifampicin, isoniazid, pyrazinamide, ethambutol) for 6 months.

• Cat-scratch disease

  • Azithromycin: 500 mg day 1, then 250 mg daily × 4 days.

• Toxoplasmosis

  • Pyrimethamine + sulfadiazine + folinic acid (specialist care).

• Viral causes (EBV, CMV, HIV)

  • Supportive care (analgesics, hydration).

  • Antiretrovirals for HIV.

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3. Autoimmune and Inflammatory Causes

• Rheumatoid arthritis, lupus, sarcoidosis

  • Treated with immunosuppressants:

    • Corticosteroids (prednisone 10–60 mg daily depending on severity).

    • Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (7.5–25 mg weekly).

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4. Malignancies

• Lymphoma and leukemia

  • Chemotherapy (e.g., CHOP regimen for non-Hodgkin’s lymphoma).

  • Radiotherapy in selected cases.

• Metastatic disease

  • Treatment depends on primary cancer site (surgery, chemotherapy, immunotherapy).

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Red Flags (Urgent Referral Required)

• Persistent lymphadenopathy >2–4 weeks without obvious cause.

• Hard, immobile, painless nodes.

• Associated systemic “B symptoms”: unexplained weight loss, night sweats, persistent fever.

• Generalized lymphadenopathy with hepatosplenomegaly.

• Supraclavicular lymphadenopathy (often malignant).

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Prognosis

• Infectious causes: usually resolve with treatment or spontaneously.

• Autoimmune causes: controlled with long-term therapy.

• Malignancy-related lymphadenopathy: prognosis depends on cancer stage and type.

• Idiopathic lymphadenopathy: often benign but requires monitoring.

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Summary of Key Treatments with Doses

• Paracetamol: 500–1000 mg PO q6h (max 4 g/day).

• Ibuprofen: 200–400 mg PO q6–8h (max 2400 mg/day).

• Amoxicillin: 500 mg PO q8h × 7–10 days.

• Penicillin V: 500 mg PO q6h × 10 days.

• Clindamycin: 300 mg PO q8h (penicillin allergy).

• Azithromycin: 500 mg day 1, then 250 mg daily × 4 days (cat-scratch disease).

• Prednisone: 10–60 mg PO daily (autoimmune/inflammatory causes).

• Methotrexate: 7.5–25 mg PO/SC weekly (rheumatoid arthritis, specialist use).

• RIPE regimen (TB lymphadenitis): rifampicin, isoniazid, pyrazinamide, ethambutol × 6 months.