Understanding Swollen Neck Glands: Causes & When to See a Doctor

Cervical lymphadenopathy (swollen neck glands) is common and usually reactive, but persistent or concerning nodes need evaluation.

Common Causes

Infectious (Most Common)

• Viral: URI, EBV (mono), CMV, HIV, HSV, measles, rubella — often bilateral, tender, mobile.
• Bacterial: Strep throat, staph, cat-scratch (Bartonella), TB (scrofula — matted, fixed), syphilis.
• Local: Dental abscess, periodontitis, tonsillitis, otitis, sinusitis — drainage-area nodes.

Autoimmune / Inflammatory

• RA, SLE, SJIA, Kawasaki, sarcoidosis, Kikuchi-Fujimoto — often bilateral, non-tender.

Malignancy

• Lymphoma: Rubbery, non-tender, fixed/matted, supraclavicular (Virchow's node = GI malignancy).
• Metastatic: SCC (HNSCC, lung), melanoma, thyroid — hard, fixed.
• Leukemia: Diffuse, often with cytopenias.

Drugs

Phenytoin, allopurinol, carbamazepine, antibiotics (DRESS), vaccines (transient).

Red Flags (Biopsy Indicated)

• Size >1.5–2 cm, increasing.
• Hard, fixed, matted, non-tender.
• Supraclavicular location.
• Duration >2–4 weeks without clear infectious cause.
• Systemic: fever, night sweats, weight loss, pruritus, alcohol pain (HL).

Workup

CBC, ESR/CRP, LFTs, LDH, HIV, EBV/CMV, TST/IGRA, SPEP, CXR. US-guided FNA or excisional biopsy (preserves architecture).

Most swollen nodes are benign/reactive. See a doctor if red flags present or uncertainty.