Dawaa Reference

chronic

Swollen Lymph Nodes (Lymphadenopathy)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BS01 - condition scope only, no dose · Lymphadenopathy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK513250/ · No dose - referral pathway, no medicine given in primary care · Lymphadenopathy - StatPearls - NCBI Bookshelf - disease-level clinical article (lymphadenopathy-full.txt)

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Lymphadenopathy - StatPearls - NCBI Bookshelf - disease-level clinical article (lymphadenopathy-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Swelling past 3 weeks counts as chronic; under 2 weeks or beyond a year is usually benign
  • Fever, chills, sweating at night, losing weight and tiredness alarm when nodes are widespread [chills · fatigue · fever · night sweats · weight loss]
  • The same complaints are unremarkable alongside neck nodes with flu or strep
  • Pain may come from inflammation, perforation, or bleeding into a necrotic malignant node [bleeding · necrosis]
  • Whether a node hurts does not reliably separate cancer from benign disease

Signs — what you find (9)

  • Generalised means nodes in 2 or more separate, non-touching regions
  • Firm rubbery nodes lean towards lymphoma, softer ones towards infection, stony hard ones towards cancer
  • Shotty nodes are small scattered lumps like shot pellets, usual in a child with a viral illness
  • Matted nodes, clustered and apparently fused, favour malignancy without proving it
  • A right supraclavicular node drains the mediastinum, lungs and oesophagus
  • Submandibular nodes take drainage from tongue, lips, mouth and conjunctiva
  • Posterior cervical nodes reflect the scalp, neck and skin of the limbs
  • Axillary nodes cover the arm, chest wall and breast
  • Inguinal nodes serve the genitals, perineum, buttock, lower abdominal wall and lower anal canal

Tests (12)

  • For unexplained widespread nodes, start with a full blood count plus manual differential and mononucleosis serology
  • White cell count and differential point towards bacterial, viral or fungal causes
  • ESR measures inflammation but settles nothing on its own
  • EBV serology confirms glandular fever behind regional nodes
  • Bartonella henselae serology identifies cat-scratch disease
  • Second-line panel: PPD, RPR, chest x-ray, ANA, hepatitis B surface antigen and HIV
  • Chest x-ray can expose tuberculosis, pulmonary sarcoidosis or a lung tumour
  • Colour Doppler tells long-standing nodes from newly active ones by their vessel pattern
  • On ultrasound, a low long-to-short axis ratio signals lymphoma or metastatic cancer
  • Tuberculosis heads the causes of both regional and widespread nodes outside industrialised countries
  • Unexplained local nodes carrying no malignancy risk can be watched for 3 to 4 weeks
  • Where results stay unclear, biopsy the most abnormal node

If not this — what else fits (12)

  • Mononucleosis
  • HIV infection
  • Tuberculosis
  • Typhoid fever
  • Syphilis
  • Cat scratch disease
  • Drug reaction, among them allopurinol, carbamazepine, phenytoin and hydralazine
  • Acute leukaemia
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma
  • Sarcoidosis
  • Systemic lupus erythematosus

SourceStatPearls "Lymphadenopathy" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Swollen glands are usually reactive to a nearby infection and settle with treatment of the cause. GP treats presumed bacterial lymphadenitis and gives analgesia, but refers if a node is hard, fixed, painless, persistent, or accompanied by systemic symptoms suggestive of lymphoma or TB. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Swollen glands are usually reactive to a nearby infection and settle with treatment of the cause. GP treats presumed bacterial lymphadenitis and gives analgesia, but refers if a node is hard, fixed, painless, persistent, or accompanied by systemic symptoms suggestive of lymphoma or TB.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • A supraclavicular node is almost always a sign of an underlying chest or abdominal malignancy.
  • Review the medication list before working a node up - allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, quinidine, sulfonamides and sulindac all cause lymphadenopathy.
  • Where there is any risk of malignancy or serious illness, go straight to biopsy rather than observing.
  • Node texture guides the differential: firm rubbery nodes suggest lymphoma, soft nodes infection or inflammation, and hard stony nodes cancer, most often metastatic.
  • Pain, or its absence, does not reliably separate a malignant node from a benign one.
  • Nodes clustered and matted together strongly indicate significant pathology.
  • Size thresholds differ by site - in an adult, an epitrochlear node above 0.5 cm is already pathological.
  • Adenopathy lasting more than three weeks counts as chronic.
  • RED FLAG - A node larger than 2 cm persisting beyond 4 to 6 weeks, a hard or immobile node, painless enlargement, generalised (multi-site) lymphadenopathy, or fever, night sweats or weight loss alongside the node.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.