What lab tests to find cause of chronic lymph node activation?

[A.B.]

I've had chronic swollen lymph nodes for many years (seen on multiple ultrasound images). Doctors have shown no interest in investigating further. Since I'm still undiagnosed after an odyssey of lab testing, I want to bring this topic up during my next visit but I don't know much about it.

What are the possible causes of chronic lymph node activation?

How do they relate to symptoms that resemble CFS?

Is there any relation to very low ESR?

Is there any relation to mildly elevated monocytes?

What lab tests are useful?

 

[lejones1]

I have the same problem, although I've only been sick for a year. Enlarged lymph nodes can be enlarged due to either malignancy or "reactive" changes (usually infection or more rarely autoimmune issues). It's also possible to have something called "shotty lymph nodes" after a viral infection - small firm nodes that never go down. If you've had them for years, that pretty much rules out malignancy. Reactive changes can be hard to find the cause of, but certainly suggest an immune issue.

You can get lymph nodes biopsied but a doctor will probably only perform one if they're large enough to be potentially cancerous - otherwise the likelihood finding anything is low.

For lab tests, it's hard to say what's useful without knowing your other symptoms because so many things can cause swollen lymph nodes. As far as autoimmune issues go, I know that lupus, rheumatoid arthritis and sarcoidosis can all cause them - I'm sure there are others as well, that's just what's been mentioned to me. Pretty much any infection - viral, bacterial, or fungal - can affect the lymph nodes. What to look for specifically may depend on where in your body the enlarged lymph nodes are.

You may want to just go for basic immunological testing if that's not something you've had - immunoglobulin panel, lymphocyte panel, NK cell function, B & T cell function...

I don't think there's any connection between lymph nodes and low ESR. ESR is a measure of inflammation in the body and if anything is probably more likely to be higher with swollen lymph nodes. Although I also have a very low ESR, I think that's just a coincidence.

 

[Thinktank]

A PET/ct scan + biopsy will pretty much show if it's malignant or benign. If it's been chronic for years then that's something you should consider doing. Just my 2 cents.

 

[Hip]

Swollen, tender or painful lymph nodes (especially in the neck or armpit) are a characteristic symptom of chronic fatigue syndrome, and in fact this symptom features in both the CDC Fukuda 1994 definition of chronic fatigue syndrome, and the Canadian Consensus definition.

You might be interested in the ideas of Raymond Perrin, who believes that blocked lymph nodes/vessels and stagnated lymph fluid underlie chronic fatigue syndrome.

Perrin says that every ME/CFS patient will have a particularly large swollen and hard lymph node in their left breast, at the location of one inch above and one inch to the left of your left nipple. I certainly do have a large swollen and hard lymph node in precisely that place.

There are quite a few threads on this forum discussing the work of Perrin. See here.


I think there should be more research into the precise cause of swollen and tender lymph nodes in CFS. I have not seen any biomedical research on this. Are the swollen/tender lymph nodes in CFS caused by a local viral or bacterial infection of the lymph nodes? Are these swollen/tender lymph nodes due to an overactivation and overworking of the immune system? Or are these swollen/tender lymph nodes due to some inflammatory process? I'd like to know the answers.


There are immunological considerations related to lymph nodes:

The lymph nodes are where dendritic cells migrate to, when they have encountered a microbial antigen, and have become activated.

If our lymph nodes are swollen and tender, might they also be dysfunctional, such that they impede the functioning of dendritic cells?

Tolerogenic dendritic cells are a particularly important class of dendritic cell whose role is to prevent autoimmunity from occurring. If there is dysfunction in the lymph nodes in CFS, might this lead to an autoimmune state?