When Are Swollen Lymph Nodes a Possible Symptom of COVID-19? Here’s What Doctors Say

Photo credit: Getty Images
Photo credit: Getty Images

At this point in the pandemic, you’re fairly familiar with the laundry list of possible COVID-19 symptoms, including a fever, chills, body aches, a dry cough, shortness of breath, and a loss of taste or smell.

However, the Centers for Disease Control and Prevention (CDC) notes that symptoms associated with the novel coronavirus can manifest uniquely in each individual, meaning one person could have a completely different experience compared to another.

One symptom you may not hear a lot about: swollen lymph nodes. Much like dizziness, back pain, or an odd skin rash, it doesn’t make the CDC’s official list of common symptoms.

However, swollen lymph nodes, especially in the neck area, are a hallmark sign of any viral or bacterial infection in the upper respiratory tract (nose, mouth, throat, etc.), says Joseph Feuerstein, M.D., director of integrative medicine at Stamford Hospital and associate professor of clinical medicine at Columbia University. “The lymph nodes are where the immune system of the neck is located, so any infection in the head or neck will cause an activation of the lymph nodes as they get inflamed,” Dr. Feuerstein says.

But do swollen glands automatically signal COVID-19? Here’s what doctors want you to know.

What are the “official” symptoms of COVID-19?

These are the most common symptoms of COVID, according to the CDC:

  • Fever or chills

  • Cough

  • Shortness of breath or difficulty breathing

  • Fatigue

  • Muscle or body aches

  • Headache

  • New loss of taste or smell

  • Sore throat

  • Congestion or runny nose

  • Nausea or vomiting

  • Diarrhea

If you’re experiencing a symptom that’s not on the CDC’s list, you should still pay close attention to how you’re feeling. Even though cases of the virus are now dropping across the country, thousands of positive coronavirus infections are still reported every day.

“Similar to other viral and even bacterial illnesses, each person may have some overlapping symptoms and some different ones,” says Sharon Nachman, M.D., chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital in New York. “Strep throats are a perfect example: Some children present with high fever, others with sore throats and mild fever, and others with abdominal pain—yet a throat swab in each case reports out the same pathogen.”

COVID-19 is similar, she notes, as the immune system response to the virus differs between people.

What typically causes swollen lymph nodes? And what do they feel like?

We have hundreds of lymph nodes—small, bean-shaped glands—throughout our body. They’re a major component of the immune system and become larger when they’re responding to an infection. Why? They collect fluid, waste, and “bad cells” to essentially filter them out of the body, per the American Cancer Society (ACS).

“The lymph fluid, traveling through lymphatic channels, contain lymphocytes (white blood cells) that help your body fight off infections and diseases—hence the swollen nodes,” says Nikhil Bhayani, M.D., an infectious disease physician with Texas Health Resources in Bedford, TX.

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And they’ll be hard to miss. “Swollen lymph nodes can feel like small, rubbery, pea-sized nodules to large, tender, boggy, cherry-sized nodules to even larger, hard, very tender, plum-sized nodules,” explains Dr. Nachman. “They are all over your body, including your neck, groin, and armpit.” However, usually just one area of nodes swells at a time, per the ACS.

Are swollen lymph nodes a possible symptom of COVID-19?

Yes, but not always. Swollen glands aren’t an immediate sign of COVID-19, but it is a possible symptom. “It is, after all, your body trying to fight the virus and stop from it going down into the chest cavity and the lungs,” says Dr. Feuerstein.

Two small studies, published in The Lancet: Infectious Diseases, suggest that swollen lymph nodes are found in under 10% of adults who had a confirmed COVID-19 infection. However, Dr. Nachman points out that it can be quite difficult to differentiate between true acutely enlarged neck lymph nodes (i.e. from a recent infection like COVID-19) from routine borderline enlarged nodes related to past viral illnesses.

“If you feel your own neck at the time of an acute viral illness, you will note that some of these nodes feel enlarged; if you check back weeks later, they will often still feel slightly enlarged,” Dr. Nachman says. “As adults, our neck node enlargement (and presence) is related to years of viral illnesses and in some cases, these never disappear but are palpable all the time, even when you’re not ill.

What to do if you have swollen lymph nodes

If you have swollen lymph nodes, especially in your neck, Dr. Lee would not immediately think of COVID-19 as a cause, unless you know of a recent exposure. Instead, she recommends focusing on other symptoms, such as fever, headache, chills, or body aches. “If you have symptoms apart from neck swelling, I recommend isolating yourself and getting tested, but if the lymph nodes are your only symptom, please reach out to your healthcare provider for a full examination,” she says.

She also highly recommends getting vaccinated as soon as you can. Just note that the COVID-19 vaccine itself may also lead to swollen lymph nodes as a side effect, particularly in the armpit area on the side you received the injection. “This is normal and a reassuring sign that your immune system is working to develop antibodies against the virus,” she says.

If you have swollen lymph nodes that feel especially hard or persist for several weeks, it is a smart idea to touch base with your doctor. “Swollen glands could be caused by a number of things, including cold and flu infections, mononucleosis, sexually transmitted illnesses, skin infections, rheumatoid arthritis, and even certain types of cancers,” says Dr. Bhayani, “all of which deserve a thorough check-up.”

This article is accurate as of press time. However, as the COVID-19 pandemic rapidly evolves and the scientific community’s understanding of the novel coronavirus develops, some of the information may have changed since it was last updated. While we aim to keep all of our stories up to date, please visit online resources provided by the CDC, WHO, and your local public health department to stay informed on the latest news. Always talk to your doctor for professional medical advice.

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