What are the effects of injecting an inflamed lymph node with a steroid?

Effects of Injecting Steroids into an Inflamed Lymph Node

Injecting steroids directly into an inflamed lymph node can reduce inflammation and symptoms but carries risks of infection, tissue atrophy, and potential systemic effects, and should be reserved for specific clinical scenarios where benefits outweigh risks.

Mechanism and Effects

Intralesional steroid injection into an inflamed lymph node works through several mechanisms:

• Anti-inflammatory effect: Steroids suppress the local inflammatory response by inhibiting cytokine production and inflammatory cell recruitment
• Reduction in lymph node size: Can decrease the physical size of enlarged, inflamed nodes
• Symptomatic relief: May provide relief from pain and tenderness associated with lymphadenitis

Clinical Applications

Intralesional steroid injections may be considered in specific scenarios:

• Tuberculous lymphadenitis: Add-on prednisolone has shown benefit in cervical lymph node tuberculosis by reducing complications and improving resolution 1
• Mesenteric lymphadenitis: Case reports show marked symptomatic improvement with corticosteroid treatment in cases resistant to antibiotics 2
• Lymphedema: Intralymphatic steroid therapy has shown preliminary benefit in reducing lymph node fibrosis and improving lymphatic flow 3
• Histoplasmosis-related lymphadenitis: Guidelines recommend prednisone (0.5–1.0 mg/kg daily for 1-2 weeks) in severe cases with compression of contiguous structures 4

Potential Risks and Complications

Several risks are associated with injecting steroids into lymph nodes:

• Local tissue atrophy: Similar to what occurs with intradermal steroid injections
• Infection risk: Particularly concerning if the lymphadenopathy is due to infection
• Systemic absorption: May cause systemic steroid effects if significant absorption occurs
• Masking underlying pathology: May delay diagnosis of serious conditions like malignancy
• Pain at injection site: Temporary discomfort during and after the procedure

Specific Recommendations Based on Etiology

For inflammatory/autoimmune causes:

• Small doses of triamcinolone (2.5-10 mg/mL) may be appropriate 5
• Consider starting with lower concentrations to minimize side effects

For infectious causes:

• Generally not recommended as first-line therapy
• If used in specific infections like tuberculosis, concurrent antimicrobial therapy is essential 1

For malignant causes:

• Contraindicated as it may mask symptoms and delay appropriate treatment
• Lymphoma risk does not appear to be increased by steroid use based on studies of patients with polymyalgia rheumatica/giant cell arteritis treated with steroids 6

Practical Considerations

When considering intralesional steroid injection:

• Diagnostic certainty: Ensure proper diagnosis before injection
• Technique: Use aseptic technique to minimize infection risk
• Dosing: Use the smallest effective dose to minimize adverse effects
• Follow-up: Monitor for resolution of symptoms and potential complications

Special Situations

Tumor-Infiltrating Lymphocyte (TIL) Therapy

• Systemic corticosteroids are generally contraindicated during TIL cell therapy as they may diminish efficacy 4
• Should only be used for life-threatening conditions if other interventions have failed

Central Nervous System Involvement

• For lymph nodes causing compression of neural structures, steroids may help reduce inflammation and prevent neurological damage 4
• Should be used for the shortest time possible with downward titration when feasible

Mycosis Fungoides/Cutaneous T-cell Lymphoma

• Intralesional corticosteroid injections may be beneficial for isolated skin lesions 4
• Should be used cautiously and in conjunction with appropriate systemic therapy

In conclusion, while intralesional steroid injection can be effective for certain inflammatory lymph node conditions, it should be used judiciously with careful consideration of potential risks and benefits. The decision to use this approach should be based on the specific clinical context, underlying etiology, and overall treatment goals.