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37<br />
TABLE 4<br />
Evaluation of Suspected Causes of Lymphadenopathy<br />
Disorder Associated findings Test<br />
Mononucleosis-type<br />
syndromes<br />
Fatigue, malaise, fever, atypical<br />
lymphocytosis<br />
Epstein-Barr virus* Splenomegaly in 50% of patients Monospot, IgM EA or VCA<br />
Toxoplasmosis*<br />
80 to 90% of patients are asympto<strong>mat</strong>ic IgM toxoplasma antibody<br />
Cytomegalovirus*<br />
Often mild symptoms; patients may have<br />
hepatitis<br />
IgM CMV antibody, viral culture<br />
of urine or blood<br />
Initial stages of HIV infection* "Flu-like" illness, rash HIV antibody<br />
Cat-scratch disease<br />
Fever in one third of patients; cervical or Usually clinical criteria; biopsy if<br />
axillary nodes<br />
necessary<br />
Pharyngitis due to group A<br />
strepto<strong>co</strong>ccus, gono<strong>co</strong>ccus<br />
Fever, pharyngeal exudates, cervical<br />
nodes<br />
Tuberculosis lymphadenitis* Painless, <strong>mat</strong>ted cervical nodes PPD, biopsy<br />
Se<strong>co</strong>ndary syphilis* Rash RPR<br />
Throat culture on appropriate<br />
medium<br />
Hepatitis B* Fever, nausea, vomiting, icterus Liver function tests, HBsAg<br />
Lymphogranuloma venereum Tender, <strong>mat</strong>ted inguinal nodes Serology<br />
Chancroid Painful ulcer, painful inguinal nodes Clinical criteria, culture<br />
Lupus erythe<strong>mat</strong>osus* Arthritis, rash, serositis, renal,<br />
neurologic, he<strong>mat</strong>ologic disorders<br />
Clinical criteria, antinuclear<br />
antibodies, <strong>co</strong>mplement levels<br />
Rheu<strong>mat</strong>oid arthritis* Arthritis Clinical criteria, rheu<strong>mat</strong>oid<br />
factor<br />
Lymphoma*<br />
Fever, night sweats, weight loss in 20 to Biopsy<br />
30% of patients<br />
Leukemia* Blood dyscrasias, bruising Blood smear, bone marrow<br />
Serum sickness*<br />
Fever, malaise, arthralgia, urticaria;<br />
exposure to antisera or medications<br />
Clinical criteria, <strong>co</strong>mplement<br />
assays<br />
Sar<strong>co</strong>idosis Hilar nodes, skin lesions, dyspnea Biopsy<br />
Kawasaki disease*<br />
Fever, <strong>co</strong>njunctivitis, rash, mu<strong>co</strong>us Clinical criteria<br />
membrane lesions<br />
Less <strong>co</strong>mmon causes of lymphadenopathy<br />
Lyme disease* Rash, arthritis IgM serology<br />
Measles* Fever, <strong>co</strong>njunctivitis, rash, <strong>co</strong>ugh Clinical criteria, serology<br />
Rubella* Rash Clinical criteria, serology<br />
Tularemiala* Fever, ulcer at inoculation site Blood culture, serology<br />
Brucellosis* Fever, sweats, malaise Blood culture, serology<br />
Plague<br />
Febrile, acutely ill with cluster of tender Blood culture, serology<br />
nodes<br />
Typhoid fever*<br />
Fever, chills, headache, abdominal Blood culture, serology<br />
<strong>co</strong>mplaints<br />
Still's disease* Fever, rash, arthritis Clinical criteria, antinuclear<br />
antibody, rheu<strong>mat</strong>oid factor
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