Site Drainage area Common causes Less common causes Cervical Head, neck, oropharynx Acute: Viral URI Lymphadenitis (bacterial, viral) Pharyngitis Oropharyngeal infections EBV Chronic: EBV, CMV Catscratch disease Nontuberculous mycobacterium (NTM) lymphadenitis Acute: Kawasaki disease Chronic: Malignancy (lymphoma, neuroblastoma, leukemia) Tularemia Toxoplasmosis Sarcoid Tuberculous lymphadenitis Histiocytosis (Langerhans cell histiocytosis, Rosai–Dorfman disease) Autoimmune lymphoproliferative syndrome (ALPS) Periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis syndrome (PFAPA) Kikuchi–Fujimoto disease, Kimura disease Submental Lower lip, gums, teeth, and floor of mouth Submandibular Cheeks, buccal mucosa, lips, gums, teeth Dental caries/infections Gingivostomatitis Dental caries/infections Gingivostomatitis Chronically cracked/dry lips Anterior Anterior/temporal Conjunctivitis auricular scalp, anterior ear (viral/bacterial) (preauricular) canal, lateral Oculoglandular syndrome of conjunctiva, and eyelids Chlamydia conjunctivitis of neonate Posterior auricular Temporal and parietal scalp Tinea capitis or other scalp infections Occipital Posterior scalp, neck Pediculosis Tinea capitis Seborrheic dermatitis catscratch disease, tularemia Rubella Parvovirus Roseola (HHV-6) Rubella Roseola (HHV-6) Rubella Supraclavicular Neck Malignancy (lymphoma or metastatic disease) Right: mediastinum, lungs Tuberculosis Left: upper abdomen Axillary Epitrochlear Inguinal Iliac Upper extremity, Upper extremity Malignancy chest wall, upper infections (leukemia, abdominal wall, Reactive adenopathy after lymphoma) breast traumatic disruption in Rheumatologic skin integrity disease of the hand/wrist Catscratch disease Toxoplasmosis Rat-bite fever Tularemia Ulnar side of hand, Local infection of hand Rheumatologic forearm disease of the hand/wrist Catscratch disease Sarcoid Tularemia Secondary syphilis Scrotum/penis, Lower extremity skin/soft Syphilis vulva/vagina, tissue infections Lymphogranuloma perianal region, Perianal fissures or venereum lower extremities, abscess Chancroid lower abdomen Genital herpes Chlamydial/gonococcal infection Lower extremities, Appendicitis Iliac adenitis abdominal UTI viscera, urinary tract FIGURE 47.3 Child with lymphadenitis that progressed to lymph node abscess There are several rare infectious causes of cervical lymphadenopathy that may be encountered in the pediatric emergency department Tularemia, caused by infection with Francisella tularensis, occurs predominantly in the South Central United States (Arkansas, Oklahoma, Missouri, and Kansas) It occurs after contact with infected animals (rabbits, hamsters) or via tick or deerfly bites The most common presentation in children is a febrile illness with tender cervical or occipital adenopathy that may become chronic An associated papular or ulcerative lesion may be noted on the skin at the site of animal contact or insect bite Diagnosis is made by detecting serum antibodies to F tularensis, and antimicrobial therapy with doxycycline or a fluoroquinolone is appropriate for mild illness Toxoplasmosis, a parasitic infection caused by Toxoplasma gondii, is acquired via contact with oocytes in cat feces or consumption of undercooked pork or lamb containing cysts Lymphadenopathy and fatigue are the most common symptoms of this self-limited illness, and adenopathy is discrete, nonsuppurative, and may persist for months in the cervical region Serologic tests are the primary means of diagnosis FIGURE 47.4 Computed tomography (CT) image of lymph node abscess ... several rare infectious causes of cervical lymphadenopathy that may be encountered in the pediatric emergency department Tularemia, caused by infection with Francisella tularensis, occurs predominantly