Causes of Unilateral Cervical Lymphadenopathy
In addition to Kawasaki disease and a reactive node from an oral inflammatory or infectious
process, the following can all cause unilateral cervical lymphadenopathy:
Bacterial
cervical
adenitis
Typically seen in children ages one to five years with a history of a recent
upper respiratory tract infection.
Staphylococcus aureus and Streptococcus pyogenes are the organisms
most commonly identified.
Patients may have high fevers and a toxic appearance.
Overlying cellulitis and development of fluctuance are common.
5/15
Cat scratch
disease
Infections caused by the bacterium Bartonella henselae can be
asymptomatic or symptomatic.
The infection usually is introduced by a scratch from a cat or kitten, with
subsequent infection of the node or nodes draining that site.
The site most commonly involved is the axilla, followed by cervical,
submandibular, and inguinal areas.
Usually a self-limited disease, with regression of the lymph node in four to
six weeks.
Mycobacterial
infection
Mycobacterial infections can cause diffuse lymphadenopathy or isolated
lymphadenitis.
Lymphadenitis is the most common manifestation of nontuberculous
mycobacteria in children, with a peak age of presentation of 2 to 4 years.
Tuberculosis is the most common cause of mycobacterial lymphadenitis in
children over 12 years of age.
Children with these infections usually appear well with minimal if any
constitutional signs and symptoms.
The overlying skin may be erythematous initially, but left untreated often
becomes violaceous as the nodes enlarge.
Nodes may rupture through the skin, resulting in a draining sinus tract.
Treatment is surgical excision, as incision and drainage can also result in a
sinus tract.