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FIGURE 47.5 Child with nontuberculous mycobacterium (NTM) lymphadenitis.

In addition to infectious causes of cervical lymphadenopathy, there are numerous
noninfectious etiologies that cause cervical node enlargement as a manifestation of
systemic disease. Such noninfectious etiologies that may be encountered in pediatric
patients include Kawasaki disease, malignancy, histiocytosis, lymphoproliferative
disorders, and periodic fever syndromes.
An important cause of acute cervical adenopathy in young children is Kawasaki
disease, or mucocutaneous lymph node syndrome (see Chapter 86 Cardiac Emergencies ).
Kawasaki disease usually affects children younger than 4 years of age and is rare after 8
years of age. Typical presentation of the disease is characterized by fever of at least 5
days’ duration, along with bilateral nonexudative conjunctivitis, changes to oral mucosa,
peripheral extremity changes, a polymorphous rash, and cervical lymphadenopathy. The
cervical lymphadenopathy in Kawasaki disease, seen in approximately 50% to 70% of
patients, occurs during the early phase of the illness and may be unilateral or bilateral.
The nodes are firm, mildly tender, and at least 1.5 cm in diameter. It is important to
diagnose Kawasaki disease early because prompt treatment with intravenous immune
globulin (IVIG) and aspirin can prevent coronary artery aneurysms, the most serious
complication of this disease.
Various malignancies, including lymphoma and neuroblastoma may present with
chronic cervical adenopathy. Lymph nodes in Hodgkin lymphoma are painless, with a
rubbery and firm consistency, and located in the cervical, supraclavicular, or axillary
regions. Palpation of such nodes in children, particularly when a history of nonspecific
symptoms such as fatigue, anorexia, and weight loss are elicited, should lead to prompt
evaluation with chest radiograph to evaluate for mediastinal masses. Neuroblastoma, most