Lymph nodes & spleen, nonlymphoma

Lymph nodes-inflammatory / reactive disorders

Acute nonspecific lymphadenitis

Last author update: 1 April 2017
Last staff update: 31 January 2023 (update in progress)

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PubMed Search: Acute nonspecific lymphadenitis

Jayalakshmi Balakrishna, M.D.
Page views in 2022: 8,030
Page views in 2023 to date: 4,002
Cite this page: Balakrishna J. Acute nonspecific lymphadenitis. website. Accessed June 5th, 2023.
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
  • Acute nonspecific lymphadenitis, nontuberculous lymphadenitis
ICD coding
  • Common, mostly affects children
  • Cervical lymph nodes are commonly affected
  • Acute nonspecific mesenteric lymphadenitis is also a relatively common in children
  • Acute inflammation of the involved lymph node / nodes due to an infectious or inflammatory 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
  • Clinical examination, exclude specific causes
  • 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
  • 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 disease and Kikuchi necrotizing lymphadenitis
Microscopic (histologic) images

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Acute lymphadenitis

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 style question #1
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 4 mm 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. Biopsy of the lymph node
B. Biopsy of the skin lesion
D. Serology
Board review style answer #1
D. 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.

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Reference: Acute nonspecific lymphadenitis
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