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What Causes Persistent Lymphadenopathy In Neck Region?

Posted on Thu, 12 Feb 2015

Question: My 17 year old son has had a persistent lymphadenopathy in his right neck. One node is greater than three cm, the other three are between one and to cm. We had labs done and the only abnormality was an ALT of 86 and an AST of 176. The doctor has ordered more specific testing for different types of hepatitis, a liver ultrasound and a CT scan of the enlarged nodes. We have a strong family history (Maternal mother, father, and brother biopsy pos for Celiacs disease). I have asked that in the follow up labs that my son's dr has ordered for in the morning that she include antibody screening for Celiacs disease. He suffered reflux chronically during infancy and primary school and had to have his gallbladder removed at age 8 for ejection fraction of 16 and terrible gall bladder pain. Other than that and taking Adderall for ADD he is in good overall health. I am of course concerned about Leukemia and Lymphoma with the nodes getting larger over the last six months and now four involved. Do you have any insight as to what might be the linking causative factor with his labs and clinical symptoms?CBC, CMP were WNL

Answered by Dr. Indu Kumar (3 hours later)

Brief Answer:
Enlarged lymph nodes may be due to scalp,ear infection etc.

Detailed Answer:
Hello

Persistent lymphadenopathy in neck region may be due to many reasons like infection in scalp and ear,tuberculosis etc.
Your son need proper clinical examination and investigations.
It is too early to conclude leukemia or lymphoma.These diseases are associated with many other features which need evaluation.Normal CBC is also against leukemia or lymphoma.
Generally,enlarged lymph nodes in neck region is due to simple reasons and only need symptomatic treatment.
FNAC of lymph nodes can be done to assess exact nature of enlarged lymph nodes.
Treatment depend upon findings.

Increased ALT indicate liver injury.It may be due to many reasons like hepatitis,altered lipid profile,medicines,auto immune causes etc.

AST is non specific and it increases in many conditions.

He may need few more investigations like ultrasound of abdomen.He is rightly advised for viral markers.

I suggest tablet ursodeoxycholic acid 300 mg twice daily for three months to my patients.It helps in regeneration of liver cells.
Specific treatment depend upon cause.

He also need screening for Celiac disease.

Get well soon.
Hope i have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Indu Kumar (20 minutes later)

The nodes have persisted for six months now. He does not seem ill in any way. The nodes are not painful in any way. No overt or clinical signs of infection. He will have further testing to rule out hepatitis (labs) in the morning and hopefully testing for celiacs disease as well. Hopefully we will rule out any serious disease processes and it will be a case of chronically enlarged nodes.

Answered by Dr. Indu Kumar (10 hours later)

Brief Answer:
I don't think there is any serious problem related to enlarged lymph node.

Detailed Answer:
Hello

I don't think there is any serious problem related to enlarged lymph node.FNAC can assess exact cause.

He also need proper evaluation regarding increased ALT.Viral markers can give clue.ANA antibodies can also be done to exclude autoimmune cause.

Get well soon.
Hope i have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju