Question

I know that tender swollen glands are often included in the list of signs and symptoms that are required to make
a diagnosis of ME/CFS. But when should we worry about enlarged lymph glands? I have several tender glands in my neck which never seem to go down.

Answer

Tender or swollen lymph nodes (known as lymphadenopathy) are quite common in people with ME/CFS. They also occur in otherwise healthy people.

These pea-sized swellings aren’t actually glands but are part of your body’s normal immune system response to illness or infection. So they indicate that your body’s immune system has been working to help clear away an infection. In the case of ME/ CFS, this might have been the infection that triggered ME/CFS. The most likely place to feel these tender or swollen glands is in your neck. But lymph nodes in your groin, under your chin and your armpits can swell up too. There are also lymph nodes throughout your body that you can’t even feel.

Lymph-node swelling in the neck is commonly caused by a sore throat or an upper respiratory infection. Enlargement can also be caused by general infections like glandular fever, autoimmune diseases such as lupus and rheumatoid arthritis and some types of prescription-only drugs. In rare situations, swollen lymph nodes can be an early warning sign of cancer, specifically, lymphoma (cancer of the lymphatic system).

Overall, swollen lymph nodes aren’t usually a cause for concern and tend go away as the infection clears up. But do see your doctor if you have any of the following symptoms that indicate that something more serious may be going on:

• Nodes that are one cm or more in diameter
• Nodes that are very painful, hard or rubbery, fixed to the skin or growing rapidly
• Nodes that are draining pus
• Symptoms like weight loss, night sweats, long-lasting fever, fatigue, difficulty breathing
• Swollen nodes close to your collarbone or lower part of your neck
• Red or inflamed skin over your swollen lymph nodes

Doctors start to worry about swollen lymph nodes when they enlarge for no apparent reason. So if you have a solitary, large, swollen gland for no apparent reason you’ll probably need to have further tests, including blood tests, and possibly an imaging scan or removal of the gland to examine its structure under the microscope.