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Coughing and Swollen Lymph Nodes: A Comprehensive Guide

What is the cause of cough and swollen lymph nodes? How are they diagnosed and treated? Explore the details in this comprehensive article.

Understanding Cough and Swollen Lymph Nodes

Coughing and swollen lymph nodes can be a concerning combination of symptoms that can have various underlying causes. These symptoms may indicate a range of health conditions, from respiratory infections to more serious underlying conditions. It is important to understand the potential causes, diagnostic procedures, and treatment options to ensure prompt and appropriate management of these symptoms.

Potential Causes of Cough and Swollen Lymph Nodes

The causes of cough and swollen lymph nodes can be diverse, including infectious, inflammatory, and malignant conditions. Some common causes include:

  • Respiratory Infections: Viral or bacterial respiratory infections, such as the common cold, influenza, or pneumonia, can often lead to cough and swollen lymph nodes.
  • Allergies and Asthma: Conditions like allergies and asthma can cause inflammation in the respiratory tract, leading to cough and swollen lymph nodes.
  • Autoimmune Disorders: Certain autoimmune conditions, such as sarcoidosis, can cause granulomatous inflammation, leading to cough and lymph node swelling.
  • Malignancies: In rare cases, cough and swollen lymph nodes may be a symptom of certain types of cancer, such as lymphoma or lung cancer.
  • Other Conditions: Less common causes may include fungal infections, certain medications, or underlying medical conditions affecting the immune system.

Diagnosing Cough and Swollen Lymph Nodes

Diagnosing the underlying cause of cough and swollen lymph nodes typically involves a comprehensive medical evaluation, including:

  1. Medical History and Physical Examination: The healthcare provider will gather information about the patient’s symptoms, medical history, and perform a thorough physical examination to identify any potential underlying conditions.
  2. Imaging Tests: Chest radiographs or computed tomography (CT) scans may be ordered to evaluate the lungs and lymph nodes.
  3. Laboratory Tests: Blood tests, such as a complete blood count, may be performed to look for signs of infection or inflammation. Specialized tests, such as cultures or biopsies, may be necessary to identify the specific cause.
  4. Bronchoscopy: In some cases, a bronchoscopy may be performed to examine the airways and collect samples for further analysis.

Treatment Approaches

The treatment for cough and swollen lymph nodes will depend on the underlying cause. Some common treatment approaches include:

  • Medications: Antibiotics, antifungal medications, or corticosteroids may be prescribed to address the underlying infection or inflammation.
  • Supportive Care: Remedies like over-the-counter cough suppressants, humidifiers, and rest may provide relief for symptoms associated with respiratory infections.
  • Lifestyle Modifications: Quitting smoking, avoiding irritants, and managing underlying conditions like allergies or asthma can help alleviate cough and swollen lymph nodes.
  • Surgical Intervention: In rare cases, surgical procedures may be necessary to address specific conditions, such as the removal of lymph nodes for diagnostic purposes.

Prognosis and Complications

The prognosis for cough and swollen lymph nodes largely depends on the underlying cause and the timely diagnosis and management of the condition. In most cases, with appropriate treatment, the symptoms can be effectively managed, and the underlying condition can be resolved. However, in some instances, complications may arise, such as respiratory distress, airway obstruction, or the spread of an underlying malignancy. Regular follow-up with a healthcare provider is essential to monitor the condition and address any complications that may arise.

Preventive Measures

While some causes of cough and swollen lymph nodes may be out of one’s control, there are several preventive measures that can be taken to reduce the risk of developing these symptoms:

  • Maintaining Good Hygiene: Regular handwashing, covering coughs and sneezes, and avoiding close contact with those who are ill can help prevent the spread of infectious diseases.
  • Smoke-Free Lifestyle: Quitting smoking and avoiding exposure to secondhand smoke can help reduce the risk of respiratory irritation and inflammation.
  • Managing Underlying Conditions: Proper management of conditions like allergies, asthma, or autoimmune disorders can help minimize the risk of developing cough and swollen lymph nodes.
  • Seeking Prompt Medical Attention: Seeking medical attention at the first signs of cough and swollen lymph nodes can facilitate early diagnosis and treatment, potentially leading to a better overall outcome.

Conclusion

Cough and swollen lymph nodes can be a concerning combination of symptoms, with a wide range of potential underlying causes. Understanding the possible causes, diagnostic procedures, and treatment options is crucial for ensuring prompt and appropriate management of these symptoms. By working closely with a healthcare provider, individuals can receive the necessary care and support to address the underlying condition and alleviate their symptoms effectively.

Hoarseness, cough and cervical lymphadenopathy

A. J. Turk, T. Brack, C. Alfaré, A. Gaspert, E. W. Russi

European Respiratory Journal 2005 26: 174-177; DOI: 10.1183/09031936.05.00137004

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CASE HISTORY

A 43-yr-old native Brazilian female complained of a sore throat, recent onset of hoarseness, progressive pain and bilateral swelling of the neck during the past 6 months, when she presented at the University Hospital of Zurich (Zurich, Switzerland) for the first time. The patient had moved to Switzerland 5 yrs before, had been a heavy smoker for the past 20 yrs and coughed chronically. She reported a short episode of minor haemoptysis 2 yrs previously that had ceased spontaneously. The patient suffered no fever or night sweats, but had lost 2 kg of weight during the past 2 months, despite a normal appetite. Five months previously, she had spent 3 months in a town south of the capital Brasilia, where she was treated with sulphamethoxazole and trimethoprim for pneumonia. After a transient recovery, the cough, sore throat and cervical swelling reappeared.

The patient’s past medical history was unremarkable for severe diseases or surgery, other than a bilateral silicon breast implant. A year before, the patient stopped taking four different drugs to lose weight, containing substances such as benzodiazepines, fluoxetine, metoclopramide and diethyl-propione, a stimulant that is commonly used as an appetite suppressant in Brazil.

The clinical examination was remarkable for enlarged, painful cervical lymph nodes and a few bibasilar rales. The patient had bilateral silicon breast implants. Her temperature was normal, white blood cell count was 10.09×10−3·μL−1 (without left shift), C-reactive protein was 42 mg·L−1 (normal: <5 mg·L−1) and HIV antibodies were negative. The chest radiograph (fig. 1⇓) taken 3 months previously in Brazil showed dense bilateral alveolar infiltrates, predominantly in the mid-zone of the lungs. A recent computed tomography (CT) scan is shown in figure 2⇓. Fine-needle aspiration of a cervical lymph node demonstrated necrotising epitheloid granulomas without acid-fast bacilli, and the culture of the aspirate did not grow mycobacteria. Bronchoscopy (fig. 3⇓) with bronchoalveolar lavage (BAL) and transbronchial biopsies were performed (figs 4⇓ and 5⇓).

Fig. 1—

Chest radiograph taken 3 months prior to the current presentation.

Fig. 2—

Thin-section computed tomography at the level of the lower lobes.

Fig. 3—

View of the larynx and vocal cords during bronchoscopy.

Fig. 4—

Transbronchial lung biopsy with a) Elastica van Gieson stain, and b) haematoxylin and eosin stain. Scale bars = 50μm (a) and 200 μm (b).

Fig. 5—

Transbronchial lung biopsy (Grocott’s hexamine-silver stain). Scale bar = 20 μm.

BEFORE TURNING THE PAGE, INTERPRET THE COMPUTED TOMOGRAPHY SCAN, THE BRONCHOSCOPIC VIEW OF THE LARYNX AND THE LUNG BIOPSY FINDINGS AND SUGGEST A DIAGNOSIS.

INTERPRETATION

Chest radiograph

The chest radiograph shows dense bilateral alveolar infiltrates, predominantly in the mid-zone of the lungs (fig. 1⇑).

Computed tomography

The CT scan reveals small, peripheral and spiculated consolidations with signs of architectural distortion. Some consolidations are surrounded by confluating air-space nodules and subtle areas of ground-glass opacities (fig. 2⇑).

Bronchoscopy

Bronchoscopy revealed an inflamed, enlarged, oedematous larynx with a cobblestone-like mucosa (fig. 3⇑) and a purulent bronchitis. BAL was remarkable for intracellular fungal spores in macrophages.

Pathology

The transbronchial biopsies demonstrated a granulomatous and interstitial inflammation with macrophages and multinucleated giant cells containing fungal spores (figs 4⇑ and 5⇑).

Culture of BAL

The fungal cultures grew Paracoccidioides brasiliensis.

Diagnosis: Paracoccidiomycosis with involvement of the cervical lymph nodes, larynx and lung.

Clinical course

The patient was treated with 2×100 mg·day−1 of itraconazole over 6 months, and promptly recovered from the cough and the hoarseness. The cervical lymphadenopathy also disappeared. A CT scan at follow-up was unremarkable except for some interstitial scarring. Retrospectively, fungal spores could be identified in the Grocott’s hexamine-silver stain of the fine-needle aspirate of the cervical lymph node.

DISCUSSION

Paracoccidiomycosis, also known as South American blastomycosis, is considered a primary systemic mycosis in contrast to the opportunistic mycoses that only affect immunocompromised patients. Other primary systemic mycoses are histoplasmosis, coccidiomycosis and North American blastomycosis. Their common habitat is the soil. The spores are inhaled and cause a primary pulmonary mycosis 1. Primary systemic mycoses are also called endemic mycoses because they occur only in certain geographical regions. Paracoccidiomycosis occurs exclusively in South America, where South Mexico (23°N latitude) and Argentina (34. 5°S latitude) build the northern and southern border of the endemic area, respectively. Approximately 60% of the cases occur in Brazil, while fewer cases are seen in Colombia, Venezuela, Argentina and Peru. Areas with the highest incidences are subtropical rainforests and damp mountain forests. The disease does not occur in hot, dry areas or in rainforests around the equator where the temperature rises above 25°C.

Paracoccidiomycosis is not transmitted among humans. Most patients with paracoccidiomycosis are male agricultural workers. The outbreak of the disease is favoured by malnutrition and alcoholism. Tuberculosis (TB) occurs as a co-infection in 12% of the cases 2. After inhalation of the fungal spores, there is often an asymptomatic or subclinical primary pulmonary paracoccidiomycosis that disappears without leaving any radiological residuals, while subclinical histoplasmosis often causes characteristic residuals, such as pulmonary granulomas and calcified mediastinal lymphomas. Many years after subclinical paracoccidiomycosis, the disease can be reactivated. In a series of patients who had immigrated to Spain, there was a mean reported latency of 14 yrs, ranging from 4 months to 60 yrs 3.

As demonstrated in the current patient, cervical and submandibular lymphadenopathy, which may be complicated by cutaneous or mucocutaneous fistulae, frequently accompany pulmonary disease. Pharyngeal ulcers and laryngitis causing throat pain and hoarseness, similar to that experienced by the present patient, are other common manifestations of the disease. In severe cases, the granulomatous laryngitis may even be mistaken for cancer 4.

Radiological manifestation of pulmonary disease is variable and ranges from alveolar to reticulo-nodular interstitial infiltrates. Frequently, perihilar butterfly-shaped opacities, cavitary lesions and traction bronchiectasies may be noted 5. Since radiographic presentation is highly variable, paracoccidiomycosis may mimic TB, sarcoidosis, Wegener’s granulomatosis or carcinoma and other systemic mycoses. Biopsies are often diagnostic because Grocott’s hexamine-silver stains paracoccidioides, which can then easily be identified within epitheloid granulomas. Fungal cultures finally confirm the diagnosis. Serological tests are available, but they are time consuming, expensive and the antibody production can be suppressed in immunocompromised patients where the detection of the specific antigen may be more helpful. Serial antibody detection can be used to document the success of the antifungal therapy.

Left untreated, paracoccidiomycosis has a high mortality rate. In 1940, sulphonamides were used for the first time as a therapy that was successful in ∼60% of patients 2. This was a 3-yr therapy, which often resulted in a relapse when the treatment was terminated precociously. Sensitivity of paracoccidioides to sulphonamides may also explain the transitory recovery of the patient during her 2-week treatment with sulphamethoxazole in Brazil. Therapy with azole-derived antifungals increased the rate of success from 60 to 90%. The current recommendation is a therapy with 100 mg itraconazole b.i.d. over 6 months. With this regimen, a success rate of 93% has been reported 2. An alternative treatment consists of ketoconazole 400 mg·day−1 over 6–18 months. Even after successful elimination of the fungus, affected organs may remain permanently damaged by fibrosis and scarring. Laryngo-tracheal stenoses and scarring of the lung are well-known, long-term sequelae.

Physicians in nonendemic areas should be aware of paracoccidiomycosis, since more cases are expected with increasing migration and international travel. Symptoms such as hoarseness, pharyngeal pain with mucosal ulcerations, cervical lymphadenopathy and chronic cough in patients with a history of travelling in South America should raise suspicion for this disease that may be reactivated after years of latent infection.

  • Received November 30, 2004.
  • highwire.org/Journal” hwp:start=”2005-02-18″>Accepted February 18, 2005.

References

  1. Kayser FH, Bienz KA, Eckert J, Zinkernagel RM. Primäre Mykosen [Primary Mycosis]. In: Medizinische Mikrobiologie. 9. Auflage [Medical Microbiology. 9th Edn]. Stuttgart, Georg Thieme Verlag, 2001; pp. 372–376

  2. Taborda AB, Arechavala AI. Paracoccidioidomycosis. In: Sarosi GA, Davies SF, eds. Fungal Diseases of the Lung. 3rd Edn. Philadelphia, Lippincott Williams & Wilkins, 2000; pp. 79–89

  3. Ajello L, Polonelli L. Imported paracoccidioidomycosis: a public health problem in non-endemic areas. Eur J Epidemiol 1985;1:160–165.

  4. Sant’Anna GD, Mauri M, Arrarte JL, Camargo H Jr. Laryngeal manifestations of paracoccidioidomycosis (South American blastomycosis). Arch Otolaryngol Head Neck Surg 1999;125:1375–1378.

  5. Bethlem EP, Capone D, Maranhao B, Carvalho CRR, Wanke B. Paracoccidioidomycosis. Curr Opin Pulm Med 1999;5:319–325.

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Symptoms of acute lymphoblastic leukaemia (ALL)

Symptoms of ALL can be similar to those caused by other illnesses. The symptoms are caused by too many abnormal white blood cells and not enough normal white cells, red cells and platelets. 

Symptoms of ALL might include one or more of the following:

  • feeling weak or tired
  • flu-like symptoms
  • a high temperature (fever)
  • picking up or not being able to shake off infections such as coughs and colds
  • bruising and bleeding easily
  • weight loss
  • swelling of your lymph nodes
  • pain in your bones or joints
  • breathlessness
  • feeling full in your tummy (abdomen)
  • looking pale or washed out

General weakness

You might feel weaker than normal.  

Feeling tired (fatigue)

You might feel more tired than normal, even if you’re getting a good nights sleep.

High temperature (fever)

You might have a high temperature or feel feverish.

Frequent infections

You might pick up infections such as coughs and colds easily. Or you might find that the infections last a long time and are difficult to shake off.

This is because you don’t have enough healthy white blood cells to fight bacteria or viruses.

Bruising or bleeding easily

You might have:

  • nosebleeds
  • bleeding gums when you clean your teeth
  • very heavy periods
  • small dark red spots on your skin
  • blood in your wee (urine) or poo (stool)

You might find you are bruising more easily than normal.

Weight loss

You might lose weight even if you haven’t changed your diet.

Swollen lymph nodes

Your lymph nodes (glands) might feel swollen when you touch them. You have lymph nodes in lots of places in your body. They might feel swollen in:

  • your neck
  • under your armpit
  • in your groin

Pain in your bones or joints

You might feel pain in your bones or joints. This might be a dull ache or more of a stabbing pain. It might be worse at different times of the day.

Too many abnormal white blood cells collecting in the bones, joints or lymph nodes may cause pain and swelling.

Feeling short of breath (breathlessness)

You might feel breathless when doing your normal day to day activities or from climbing a short flight of stairs. This could be because you do not have enough red blood cells. 

Feeling full in your tummy (abdomen)

You might have a feeling of fullness or discomfort in your tummy (abdomen). This can happen if your liver or spleen are swollen.

Pale skin

You might look paler or more ‘washed out’ than normal. 

Other symptoms

A type of leukaemia called T cell ALL can cause swollen lymph nodes in the centre of your chest. It might make the thymus gland in your upper chest bigger. The swollen nodes or thymus gland may press on the windpipe, causing breathlessness and coughing.

They can also press on the veins carrying blood from the head. This causes pressure in the blood vessels and makes the face, neck and arms swell and go red. This is called superior vena cava obstruction (SVCO).

Go to the accident and emergency (A&E) department at your nearest hospital if you have any of these symptoms. It can be a medical emergency.

When to see your doctor

You should get any of these symptoms checked by your GP. But remember, they can all be caused by other medical conditions. Most people with these symptoms don’t have leukaemia.

  • Suspected cancer: recognition and referral
    National Institute for Health and Care Excellence (NICE), June 2015. Last Updated January 2021

  • Scottish Referral Guidelines for Suspected Cancer
    NHS Scotland, Last Updated October 2020

  • Hoffbrand’s Essential Haematology (8th Edition)
    AV Hoffbrand and D A Steensma
    Wiley Blackwell, 2020

  • Cancer: Principles and Practice of Oncology (11th edition)
    V T De Vita, T S Lawrence and S A Rosenberg
    Wolters Kluwer, 2019

  • Acute lymphoblastic leukaemia
    F Malard and M Mohty
    The Lancet, 2020. Volume 395, Issue 10230, Pages 1146 to 1162

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact [email protected] with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 

18 May 2021

Next review due: 

18 May 2024

Basic methods for diagnosing sore throat and swollen lymph nodes
Diagnostic method Time
Blood analysis 10 minutes
Analysis of urine 5 minutes
X-ray of the jaw 10 minutes