4. When the cause remains uncertain after the initial evaluation: - Lymph node ≥2 cm (0.8 inches) in longest diameter and tender:
- Initiate 10 to 14 day trial of antibiotic therapy, broadened as indicatedΔ
- Regression in size: No additional evaluation or therapy
- No regression in size: Obtain CBC/differential, ESR/CRP, CXR, TST, Bartonella henselae serology and provide referral or treatment based on the results
- Lymph node ≥2 cm (0.8 inches) in longest diameter, nontender, with symptoms/signs of infection within or distal to node
- Obtain bacterial and fungal cultures or other fungal studies as indicated by the initial evaluation◊, B. henselae serology, and provide a 10 to 14 day trial of antibiotic therapy, broadened as indicatedΔ
- Regression in size: No additional evaluation or therapy
- No regression in size: Obtain CBC, ESR/CRP, and CXR to evaluate worrisome features*
- Lymph node ≥2 cm (0.8 inches) in longest diameter, nontender, no symptoms/signs of infection within or distal to node
- Obtain CBC/differential, ESR/CRP, LDH, CXR and abdominal ultrasonography
- Worrisome features*, abdominal mass, or abdominal lymphadenopathy: Proceed to biopsy¶
- No worrisome features*, no abdominal mass or lymphadenopathy, and cause remains uncertain: Perform TST and provide a 10 to 14 day trial of antibiotic therapy broadened as indicatedΔ
- TST positive: Additional testing may be necessary to establish diagnosis of tuberculosis or NTM
- TST negative and lymph node regresses in size: No additional evaluation or therapy
- TST negative, lymph node does not regress: Obtain additional microbiologic studies as indicated by the history and examination◊ and provide referral or treatment based on the results
- Lymph node <2 cm (0.8 inches) in longest diameter:
- Worrisome features*: Proceed to biopsy¶
- No worrisome features*: Continue to observe, even if the lymph node does not regress after four weeks
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