Lymphadenitis: Causes, Symptoms, and Treatment Options

Lymphatic tuberculosis

Hello Dr.
Tsai,
My father has been experiencing fever for two consecutive weeks since mid-September, but the fever only lasts for one day before subsiding.
Later, we noticed a swelling under his ear that became red, swollen, and painful, and it increased in size.
After discovering that his white blood cell count reached over 19,000, he was hospitalized at a local hospital for a week.
Although his white blood cell count did not decrease, the swelling significantly reduced.
Subsequently, due to general weakness, he sought treatment at Taichung Veterans General Hospital, where he was hospitalized for another week specifically to manage his white blood cell count, which decreased to over 13,000.
The hospital informed us that he could be discharged to continue medication at home.
However, within a week, the swelling under his ear increased again, becoming red and painful, accompanied by high fever (around 38 degrees Celsius) lasting for three days, along with persistent weakness.
He was readmitted to the emergency department at Veterans General Hospital, where he received injections and medication for another week, which managed to control his symptoms.
The doctor arranged for a biopsy of the swelling, and the results indicated it was benign.

Despite this, the symptoms keep recurring; it seems that as long as he is hospitalized and receiving IV treatment, his condition stabilizes.
After returning home, he continues to take the same medications as in the hospital, but within a week, he experiences high fever and weakness again.
This past Tuesday, he even vomited and fainted due to the high fever while in the hospital.
Each time he is discharged, I notice that his complexion worsens and he becomes increasingly fatigued.

I sincerely request your medical advice and insights regarding his condition and the underlying causes.
Thank you very much in advance.

JIAO YI, 30~39 year old female. Ask Date: 2004/11/24

Dr. Cai Hongyan reply Otolaryngology

Hello! 1.
Due to the presence of lymph nodes in the parotid gland, any lymphatic-related diseases should be considered.
2.
In theory, a biopsy will determine the direction of treatment; if there is still a persistent high fever, other causes should be considered.
3.
Trust in Chung Cheng Hospital! It is a medical center level facility.

Reply Date: 2004/11/24

More Info

Lymphadenitis, an inflammation of the lymph nodes, can be a complex condition with various underlying causes, symptoms, and treatment options. Based on your father's situation, it appears he is experiencing recurrent episodes of fever, swelling, and pain in the lymph nodes, particularly in the area beneath the ear. This can be distressing not only for the patient but also for family members witnessing the ongoing health struggles.

Causes of Lymphadenitis
Lymphadenitis can be caused by a variety of factors, including:
1. Infections: The most common cause of lymphadenitis is an infection, which can be bacterial, viral, or fungal. In your father's case, the recurrent fevers and swollen lymph nodes suggest a possible bacterial infection, which may not have been fully resolved with initial treatments.

2. Localized Infections: Conditions such as dental infections, ear infections, or skin infections can lead to localized lymphadenitis. If there is an ongoing source of infection in the head or neck region, it could explain the persistent symptoms.

3. Systemic Infections: Conditions like mononucleosis or HIV can also cause generalized lymphadenopathy and fever.
4. Non-Infectious Causes: Less commonly, lymphadenitis can be due to autoimmune diseases or malignancies, although the biopsy results indicating a benign condition suggest that this is less likely in your father's case.

Symptoms of Lymphadenitis
The symptoms of lymphadenitis can vary but typically include:
- Swollen, tender lymph nodes
- Fever and chills
- Fatigue and malaise
- Redness and warmth over the affected area
- Pain when touching the swollen lymph nodes
In your father's case, the recurrent fever and the painful, swollen lymph nodes indicate that the inflammation is significant and may require further investigation to identify the underlying cause.

Treatment Options
The treatment for lymphadenitis largely depends on the underlying cause:
1. Antibiotics: If a bacterial infection is suspected, antibiotics are typically the first line of treatment. However, if the infection is not responding to initial antibiotic therapy, it may be necessary to reassess the situation. This could involve changing the antibiotic or considering the possibility of a resistant organism.

2. Supportive Care: This includes rest, hydration, and over-the-counter pain relievers to manage fever and discomfort.

3. Surgical Intervention: In some cases, if there is an abscess (a collection of pus) or if the lymphadenitis is due to a localized infection that does not respond to antibiotics, surgical drainage may be necessary.

4. Further Investigations: Given the recurrent nature of your father's symptoms, it may be beneficial to conduct further tests. This could include imaging studies (like ultrasound or CT scans) to assess the lymph nodes and surrounding tissues, or additional blood tests to evaluate for underlying infections or other conditions.

5. Monitoring and Follow-Up: Continuous monitoring of symptoms and regular follow-ups with healthcare providers are crucial. If symptoms persist or worsen, it may be necessary to consult with a specialist, such as an infectious disease expert or an oncologist, depending on the findings.

Conclusion
Your father's situation is understandably concerning, especially with the recurring symptoms and the impact on his overall health. It is essential to maintain open communication with his healthcare team, ensuring that all symptoms are reported and that any changes in his condition are promptly addressed. If the current treatment plan is not effective, advocating for further evaluation and possibly seeking a second opinion may be warranted.
In summary, lymphadenitis can be a challenging condition to manage, particularly when it is recurrent. Understanding the potential causes and treatment options can help guide the next steps in your father's care. It is crucial to remain proactive in seeking answers and ensuring that he receives the appropriate care to improve his quality of life.

Similar Q&A

Understanding Neck Lymphadenitis: Causes, Diagnosis, and Treatment Options

Lymphadenitis of the sternocleidomastoid muscle has been evaluated through neck and chest X-rays, blood tests, and imaging studies, all of which returned normal results. Two neck ultrasounds were performed; one doctor suggested muscle inflammation while another indicated lymphati...

Dr. Zheng Jueyi reply Otolaryngology
Hello, if multiple examinations have shown no abnormalities, it is mostly a benign condition, and observation is recommended. If the lymph nodes continue to enlarge or become painful, further medical evaluation is advised. A lymph node biopsy can provide useful information, but i...

Understanding Lymph Node Swelling: Causes and Treatment Options

Three weeks ago, a lump about 1 cm in size suddenly appeared on my neck. It hurts when pressed firmly by the doctor and feels somewhat hard. I visited a clinic, and the doctor suggested it might be lymphadenitis and prescribed medication to manage it. After taking the medication,...

Dr. Zheng Jueyi reply Otolaryngology
Hello, it is common to experience lymphadenitis. It is recommended to continue monitoring and to avoid excessive manipulation. If the size continues to enlarge, further medical evaluation is necessary. Wishing you safety and health. Sincerely, Dr. Cheng Jue-Yi, Director of the De...

Understanding Lymphadenitis: Symptoms, Treatment, and When to Seek Help

I would like to ask the doctor about some symptoms I've been experiencing. Two weeks ago, I noticed a lump on the right side of my jaw and neck that hurts when pressed. My throat also hurts, and I have two sores on my tongue that are more painful than usual mouth sores (all ...

Dr. Ji Zhaoyun reply Otolaryngology
Hello, based on your description, it is most likely that you are experiencing pharyngitis, tonsillitis, and oral ulcers accompanied by cervical lymphadenopathy. Treatment typically involves the use of medications, and antibiotics may be necessary if the lymphadenopathy continues ...

Understanding Painful Lymph Nodes: Causes and Treatment Options

Duration: 3 weeks Symptoms: Recently, I have been able to feel swollen lymph nodes on both sides of my earlobes and under my jaw, with tenderness upon pressure. Could this be caused by sinusitis leading to post-nasal drip, which in turn has triggered tonsillitis? It has been 3 ...

Dr. Cai Hongyan reply Otolaryngology
1. It should be. 2. Generally, it will reduce swelling and relieve pain; if it persists for more than three months, a biopsy should be performed. 3. Blood tests can be done but are not necessary.