Abstract
Introduction and study aim: prolonged fever and lymphadenopathy (LAP) are two interrelating features that constitute a diagnostic challenge in medical practice. With the great variety in differential diagnoses, a wise clinical impression is needed to reach a provisional diagnosis. This is achieved through knowledge and awareness of the prevalent etiologies among our population. Patients and methods: We included 269 patients with prolonged fever and lymphadenopathy to have an excisional biopsy to reach a definitive diagnosis via histopathological examination. In addition, laboratory tests were performed to assess the role of serology to predict probable diagnoses. Results: Three main etiologies of prolonged fever and lymphadenopathy were detected; malignancy (41.7%), followed by non-specific changes (reactive hyperplasia) (30.5%), then infections (27.8%). The most commonly involved lymph nodes were cervical and axillary, then inguinal. More than half of the patients had only fever and lymphadenopathy, while cachexia and anorexia were the most common associated presentations among others. Most of the patients had high ESR level, whereas high LDH and CRP levels presented in nearly 34% and 22% of them respectively. High CRP, eosinophilia and elevated LDH, characterized malignancy whilst infection was commonly associated with lymphocytosis, monocytosis and high ESR. Old age and high ESR were significant independent predictors of malignancy, and lymphocytosis was a significant predictor of infection. Conclusion: In our region, malignancy is the commonest etiology for fever and lymphadenopathy, in addition to reactive hyperplasia and infections, respectively.
Highlights
Lymph nodes of abnormal size, number, and consistency are known as lymphadenopathy (LAP)
When patients’ features were compared based on their pathological diagnosis, we found that old age was characteristic of malignancy, while there was no gender gender-predominance among different diagnoses (Table 2)
In univariate and multivariate analysis, we found that increasing age (OR=1.06, 95% CI=1.04– 1.08) and high Erythrocyte Sedimentation Rate (ESR) (OR=0.16, 95% CI=0.06– 0.42) were significant independent predictors of malignancy, and lymphocytosis was a significant predictor of infection (OR=1.99, 95% CI=1.04 – 3.83)
Summary
Lymph nodes of abnormal size, number, and consistency are known as lymphadenopathy (LAP). Some lymph nodes have different sizes based on their site, and the individual’s age. Evaluation of a case with lymphadenopathy is challenging because of the extensive related differential diagnoses and their diversity among different regions. For making a provisional diagnosis, it is crucial to have familiarity with the etiologic pattern of lymphadenopathy in a given geographical area [1]. LAP is mainly attributed to infectious etiologies including upper respiratory tract infections, cytomegalovirus, and Epstein–Barr Virus. While in countries with low socioeconomic status, tuberculosis (TB), toxoplasmosis, leishmaniasis, HIV, and fungi are predominate causes
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
More From: Afro-Egyptian Journal of Infectious and Endemic Diseases
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.