Chronic cervical lymphadenitis
Chronic cervical lymphadenitis has a duration of longer than 6 weeks.
Consider Mycobacterium tuberculosis (see Tuberculosis) in patients from Aboriginal and Torres Strait Islander populations1, potentially exposed patients and those born in countries where tuberculosis is endemic. Consider HIV infection in potentially exposed patients and those born in high-prevalence countries.
Adults with chronic cervical lymphadenitis require evaluation (starting with an ultrasound) for noninfective causes (eg cancer) if history and examination do not identify a cause. Consider further imaging and lymph node biopsy; investigations should be guided by expected aetiology – seek expert advice.
Chronic cervical lymphadenitis is more common in children. The likelihood of potential causes and the need for further investigation are guided by the size, shape, texture and distribution (eg localised or generalised) of the lymphadenitis, and changes over time, as well as the presence or absence of systemic symptoms. Causes can be infective or noninfective; noninfective causes include dermatitis, autoimmune conditions and (rarely) cancer. Consider additional investigations (eg ultrasound) to exclude cancer if prolonged, painless and firm lymphadenitis is present.
Nontuberculous mycobacterial infection (in particular Mycobacterium avium complex [MAC] infection) is the most common cause of chronic cervical lymphadenitis in Australian children, especially those younger than 5 yearsTebruegge, 2016. It presents with slow unilateral painless swelling without localised increased temperature, and (if superficial) overlying red-purple discolouration of skinLopez-Varela, 2015Mahadevan, 2016. Referral to a specialist is required; surgical excision may be indicated. See also Nontuberculous mycobacterial infections.
Bartonella henselae (see Bartonella infections), Toxoplasma gondii and other mycobacteria (eg Mycobacterium tuberculosis complex) are less common causes of chronic cervical lymphadenitis in children.