What are the causes of reactive lymph nodes in pediatrics?

From the Guidelines

Reactive lymph nodes in pediatric patients are typically a normal immune response to infection or inflammation and do not require immediate medical attention unless they exhibit concerning characteristics, such as being larger than 1 cm, hard, fixed, tender, or associated with systemic symptoms like fever, weight loss, or night sweats. When evaluating reactive lymph nodes in children, it is essential to consider the size, mobility, and tenderness of the nodes, as well as the presence of any accompanying symptoms. According to the NCCN Guidelines for Pediatric Aggressive Mature B-Cell Lymphomas 1, pediatric aggressive mature B-cell lymphomas, including Burkitt lymphoma and diffuse large B-cell lymphoma, are the most common types of non-Hodgkin lymphoma in children. However, these guidelines primarily focus on the management of sporadic pediatric Burkitt lymphoma and diffuse large B-cell lymphoma, rather than reactive lymphadenopathy.

Some key points to consider when evaluating reactive lymph nodes in pediatric patients include:

• Observation is usually recommended for lymph nodes that are mobile, soft, non-tender, and less than 1 cm in diameter.
• Medical evaluation is warranted for lymph nodes that are larger than 1 cm, hard, fixed, tender, or associated with symptoms like fever, weight loss, or night sweats.
• No specific medication is typically needed for reactive lymphadenopathy as it often resolves spontaneously once the underlying infection clears.
• Parents should monitor the lymph nodes for 2-4 weeks, and if they persist or increase in size, a healthcare provider should be consulted.
• Diagnostic tests may include complete blood count, throat culture, or imaging studies if necessary, as outlined in the NCCN Guidelines 1.

It is crucial to note that while reactive lymphadenopathy is generally a benign condition, it can be a symptom of more serious underlying diseases, such as infectious mononucleosis caused by Epstein-Barr virus (EBV) or other viral illnesses. Therefore, a thorough medical evaluation is necessary to determine the underlying cause of the reactive lymph nodes and to rule out any potential malignancies.

From the Research

Reactive Lymph Nodes in Pediatrics

Reactive lymph nodes in children can be caused by a variety of conditions, ranging from benign to malignant. The following are some key points to consider:

• Reactive lymph nodes are common in the pediatric population and may be clinically striking 2
• Benign lymphadenopathy is more common than malignancy in children, with infection and reactive lymphoid hyperplasia being the most common causes 3
• Ultrasound is the initial imaging modality of choice for pediatric cervical lymphadenopathy and can provide critical information to aid in diagnosis 3
• Clinical factors that may predict malignancy include lymph node size greater than 2-3 cm, multiple levels of adenopathy, and supraclavicular location 3, 4
• Systemic symptoms, such as fever, weight loss, and fatigue, can also be indicative of malignancy 4
• Laboratory findings, such as anemia, leukocytosis, and increased erythrocyte sedimentation rate, can be associated with malignancy 4

Diagnosis and Evaluation

The diagnosis and evaluation of reactive lymph nodes in children involve a combination of clinical assessment, laboratory tests, and imaging studies. Some key points to consider:

• Point-of-care ultrasound can be a valuable tool in the diagnosis and evaluation of lymph node pathologies in children 5
• The sonographic features of reactive lymph nodes can be distinguished from those of infectious, inflammatory, or malignant processes 5
• A lymph node biopsy may be necessary in some cases to confirm the diagnosis and rule out malignancy 3, 4
• The decision to perform a biopsy should be based on a combination of clinical, laboratory, and imaging findings 3, 4

Management and Follow-up

The management and follow-up of reactive lymph nodes in children depend on the underlying cause and the severity of the condition. Some key points to consider:

• Most cases of benign lymphadenopathy can be managed conservatively with observation and follow-up 3
• Children with persistent or worsening symptoms, or those with suspicious findings on imaging or laboratory tests, should be referred for further evaluation and management 3, 4
• Early biopsy should be considered in patients with a high risk of malignancy, such as those with systemic symptoms, abnormal laboratory findings, or suspicious imaging findings 4