lymphadenopathysplenomegaly

Lymphadenopathy and splenomegaly refer to enlargement of lymph nodes and of the spleen, respectively. When they occur together, they often indicate a systemic process rather than a localized condition. A wide range of conditions can cause both findings, including infections, hematologic disorders, autoimmune diseases, and malignancies.

Common infectious causes include Epstein-Barr virus, cytomegalovirus, and other viral infections; bacterial infections such as endocarditis or tuberculosis; and parasitic or fungal processes in certain regions. Hematologic malignancies such as leukemia and lymphoma frequently present with enlarged nodes and spleen. Autoimmune and inflammatory diseases, notably systemic lupus erythematosus and certain vasculitides, can produce both findings. Storage and infiltrative disorders (for example Gaucher disease or amyloidosis) and conditions causing portal hypertension or other splenic congestion may also present with splenomegaly accompanied by lymphadenopathy.

Evaluation typically starts with a detailed history and physical examination, followed by laboratory tests such as complete blood count with differential, platelets, liver function tests, and markers of inflammation. Serologic testing for infections (eg, EBV, HIV, CMV) and autoimmune workups may be indicated. Imaging commonly begins with ultrasound to assess lymph nodes and splenic size; CT or MRI can be used for further characterization. Lymph node biopsy is considered if nodes are persistent, enlarging, hard, or supraclavicular, to distinguish reactive from malignant processes. Bone marrow biopsy may be necessary when hematologic disease is suspected.

Management depends on the underlying cause. Many infectious and inflammatory conditions improve with appropriate therapy; malignancies and autoimmune diseases require disease-specific treatment. Protective measures for the spleen (including vaccination and avoidance of trauma) are important in cases of significant splenomegaly or functional asplenia. Prognosis varies with the etiology and stage of any underlying disease.