It can include virtually all known causes of lymphadenopathy. As a general rule the diagnosis is favored by chronicity, unilateral occurrence, tenderness and characteristic sites of involvement, such as the axillary, epitrochlear and preauricular nodes. Cervical, femoral, inguinal and generalized lymph node involvement is less specific for CSD and necessitates more care in differential diagnosis. Tularemia, toxoplasmosis, plague, and Kawasaki disease must be considered because of the need for specific therapy. They persist until the development of lymphadenopathy, which generally occurs in 1 to 4 weeks.
Affected nodes are usually tender, red and indurated.
The duration of enlargement is 4-6 weeks, with persistence up to 12 months. The majority of patients lack constitutional symptoms. The most serious complication of CSD is involvement of the CNS in the form of encephalitis or encephalopathy. High fever and convulsions develop within 6 weeks of the onset of lymphadenopathy followed by alteration in the level of consciousness, headache and muscle weakness. The CSF is normal or shows minimal pleocytosis or elevated protein content.