Chronic lymphadenitis is a prolonged, low-grade inflammation of lymph nodes, usually lasting more than six weeks. It often follows inadequately treated acute infections, mycobacterial disease, or persistent immune stimulation. Typical features include:

1. Painless or mildly tender rubbery nodes
   Lymph nodes enlarge slowly to 1–3 cm, feel firm but not hard, and remain mobile beneath the skin.
2. Persistent swelling without redness
   Overlying skin looks normal; heat, erythema, and fluctuation are absent unless secondary infection occurs.
3. Waxing and waning course
   Nodes may reduce slightly between flares but never return to baseline size, especially after minor upper-respiratory infections.
4. Mild systemic symptoms
   Low-grade evening fever, easy fatigability, or night sweats can appear, but high fever and rigors are uncommon.
5. Sinus tract or matting (special settings)
   In mycobacterial disease the overlying skin becomes thin, violaceous, and may form a chronic draining sinus; several nodes can mat together.
6. Regional source signs
   Look for chronic dental caries, tonsillar infection, tuberculosis contact, or cat-scratch history that sustains the nodal reaction.
7. Absence of weight loss and B-symptoms
   Unlike lymphoma, chronic lymphadenitis rarely produces >10 % weight loss, drenching sweats, or hepatosplenomegaly; if present, biopsy is mandatory.

Any node >2 cm that remains palpable for more than six weeks, becomes progressively firmer, or develops overlying skin changes warrants ultrasound, chest X-ray, and fine-needle or excisional biopsy to exclude tuberculosis or neoplasia.