Patient handout

Lymphadenopathy (localised / generalised / by location + features)

PRODUCTION

1. Your condition

This handout is for lymphadenopathy (localised / generalised / by location + features). Your care team identified this based on: palpable lymph node noted by patient or clinician (bazemore afp 2002 pmid 12484692).

Other reasons your team may use this plan: incidental lymphadenopathy on imaging (nccn 2024); lymphadenopathy + b symptoms (fever, night sweats, >10% weight loss / 6 mo) — lymphoma signature (lugano cheson 2014 pmid 25113753); supraclavicular node any size — highly concerning (>90% pathologic in adults; virchow = abdominal malignancy).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
cephalexin	500 mg	PO	q6h × 7-10 d	Empiric outpatient — covers most strep/staph (Bazemore 2002 PMID 12484692)
clindamycin	300-450 mg	PO	q6-8h × 7-10 d	CA-MRSA coverage; D-test for inducible resistance
doxycycline	100 mg	PO	BID × 14 d	IDSA — cat scratch in severe / immunocompromised (Florin Klotz 2008 PMID 21243990)
azithromycin	500 mg day 1 then 250 mg	PO	daily × 5 d	Cat-scratch first-line in mild disease (Bass 1998 RCT); MAI pediatric option alongside excision (Florin 2008 PMID 21243990)

Plan: Directed antibiotic for bacterial / atypical lymphadenitis (selected cases)

3. When to call your provider

Contact your care team if any of the following happen:

Rapid growth (doubling in <2 wk) → expedited biopsy referral + ED if cytopenia
NEW B-symptoms → urgent biopsy referral
NEW cytopenias on CBC → admit + heme-onc
NEW supraclavicular node at ANY size → expedited surgical onc within 1-2 wk
Airway / SVC compression → ED

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Supraclavicular lymph node palpable at ANY size — left = Virchow → abdominal malignancy; right = mediastinal / lung primary
Persistent LAD + ≥1 of: fever >38°C, drenching night sweats, unintentional ≥10% weight loss in 6 mo (Lugano Cheson 2014 PMID 25113753)
LAD + blasts on peripheral smear OR pancytopenia OR isolated cytopenia (NCCN 2024)(life-threatening)
Hard / matted / fixed / painless node in any region — malignancy signature regardless of size (Bazemore AFP 2002 PMID 12484692)
Node doubling in size within ≤2 weeks (NCCN 2024)
Mediastinal mass on CXR with stridor, dyspnea, orthopnea, SVC syndrome features (facial swelling, distended neck veins, plethora) (NCCN 2024)(life-threatening)
New drug (2-8 wk latency) + LAD + morbilliform rash + eosinophilia ≥1500 OR atypical lymphocytes + LFT rise (>2× ULN) ± fever ± facial edema → DRESS (RegiSCAR Kardaun 2013 PMID 23855313)(life-threatening)
LAD with acute upper airway compromise — stridor, drooling, voice change, accessory muscle use (NCCN 2024)(life-threatening)

5. Follow-up

Heme-onc if lymphoma / leukemia; ID if TB / HIV / Bartonella; rheumatology if SLE / sarcoid; dermatology if DRESS; surgical onc if metastatic carcinoma (NCCN 2024)

6. Sources

Guideline: Bazemore/Smucker AFP 2002 lymphadenopathy algorithm + Habermann/Ferrer NEJM 2002 review + Lugano classification (Cheson 2014) + NCCN B-cell + Hodgkin lymphoma 2024 + WHO 2022 lymphoma classification + RegiSCAR DRESS 2013