Lymphadenitis in children and adolescents: cause for oncologic suspicion?

Objective: to analyze the causes and clinical course of lymphadenitis in children and adolescents for timely detection of cases of malignant lymphadenopathy. Materials and Methods: A clinical observational study of 268 patients diagnosed with lymphadenitis was conducted between January 2019 and December 2023. Results: Lymphadenitis was the most frequent (56.5%) form of lymphadenopathy of unspecified cause at the time of the first medical examination. The structure was composed of: infectious diseases, including tuberculosis lesions (30.6%), herpesviral infections (5.6%), cat scratch disease (1.9%), urogenital (1.9%), dental and otorhinolangiologic pathologies (1.9%). Lymphadenitis of unspecified etiology accounted for 56.0% of cases in which symptoms regressed on empirical therapy. Isolated tuberculous lesions of peripheral lymph nodes were rare (1.1%). The median age was 8.0 (5;12) years, lymphadenopathy was detected more often in children 4—11 years old, the ratio of boys:girls was 1:1.4. The time from symptom onset to treatment was 5 days. Cervical and inguinal lymph nodes were most often affected (48.3%), dense or dense-elastic (89.1%) and painful (87.3%), the median size of lymph nodes was 2.0 (1.3; 3.0) centimeters. According to the ultrasound data, the lymph nodes was most often marked by decreased echogenicity (88,9%), heterogeneous echo structure (71,9%), with increased or normal blood flow (100,0%), presence of preserved lymph nodes capsule. Antibacterial therapy was administered to the majority of patients (83.3%). No improvement was observed in 27 patients (17.4% of patients receiving antibiotic therapy) who received repeated courses.