Lymphadenopathy

Enlarged lymph nodes, up to 2cm in the neck are common. Causes include local infection, generalized viral infections and bacterial lymphadenitis. Rarer causes are tuberculosis, malignancy and BCG or MAIS disease. HIV disease usually causes generalized lymphadenopathy. 

If no obvious cause is present (eg tonsillitis, skin sepsis) treat empirically for lymphadenitis with cephalexin. If nodes do not resolve in 2 weeks or if suspicion exists of a rarer cause, do a CXR and mantoux, FBC,diff count, peripheral blood smear, ESR and CRP. If results are abnormal, manage accordingly. 

Indications for FNB or excision biopsy include 

• Failure to respond to antibiotics 
• Present for > 3 months 
• Increasing in size > 2cm in diameter 
• Firm, hard or matted consistency 
• Supraclavicular lymph nodes