weight loss, night sweats, arthralgias, rashes, and bruising or petechiae that may suggest underlying systemic pathology and prompt more aggressive evaluation Social history and ill contacts of children also provide important information in constructing a differential diagnosis Ill contacts of children at school or in the home, particularly affected by viral respiratory infections, infectious mononucleosis, or group A streptococcus infections, should be noted Inquiry about a child’s close contacts with a diagnosis of tuberculosis, symptoms of active disease, travel, or risk factors for acquisition is imperative when considering tuberculous adenitis Asking about pets (cats or fish tanks), residence (exposure to livestock), recent travel or outdoor activity (animal exposure and insect bites), and dietary patterns (consumption of unpasteurized milk or cheese, or undercooked meats) can provide key information in a given clinical context Finally, the clinician must ask about medication use and whether any prior treatment, such as antibiotic therapy, treatment with glucocorticoids, or attempted aspiration with cultures, has been initiated For example, children with NTM adenitis or Kawasaki disease may present to the emergency department after a course of antistaphylococcal antibiotic therapy failed to reduce the size of the node This information can often guide the physician to include or exclude certain diagnoses The importance of avoiding glucocorticoids prior to making a definitive diagnosis of the cause of lymphadenopathy should be emphasized Glucocorticoid treatment can mask or delay the histologic diagnosis of malignancy such as leukemia or lymphoma, and should not be given empirically to decrease node swelling The physical examination should include a careful measurement of the size of the enlarged nodes and documentation of the number of nodes involved to provide an adequate baseline for follow-up Describing a node’s consistency (soft, firm, rubbery, indurated, fluctuant), mobility (mobile or fixed), and degree of tenderness to palpation is essential Skin changes around the node (erythematous and edematous, or violaceous and paper-thin) should be noted Lymphadenopathy in any region should prompt examination of lymph nodes in all regions to assess for generalized involvement Finally, a complete physical examination noting rashes, hepatosplenomegaly, joint swelling, or other abnormalities is critical In well-appearing children without systemic symptoms, further evaluation of acute localized lymphadenopathy is generally unnecessary Children with symptoms of lymphadenitis (a unilateral node with erythema, edema, or tenderness) can be empirically treated with a 10- to 14-day course of antibiotics with MRSA coverage and reevaluated There are several predictors for a suppurative adenitis that may require surgical drainage These can be independently used in the decision-making process for diagnostic imaging and surgical consultation; absence of pharyngitis, age ≤3 years, WBC >15,000/mm3, and anterior cervical chain location Children without symptoms of an acute bacterial lymphadenitis can be observed over the same time course, provided they have no enlargement of the adenopathy and lack worrisome constitutional symptoms Reactive adenopathy that occurs after a viral illness typically resolved within to weeks