How would you approach localized lymphadenopathy in a patient with lupus whose symptoms are otherwise well-controlled?

Localized adenopathy in lupus is infrequent and the differential is broad including nonspecific reactive hyperplasia as part of underlying illness or local trigger, infectious (e.g., suppurative in association with staph or strep, MTB, atypical mycobacterium, fungal, etc), lymphoma (e.g., Hodgkin's and NHL), Kikuchi-Fujimoto (i.e., necrotizing histiocytic lymphadenitis), Castelemen's syndrome (angiofollicular hyperplasia with HHV8), and AILD (angioimmunoblastic lymphadenopathy). Other uncommon c...

In our cohort, 15% of patients developed lymphadenopathy during their disease course mostly occurring within the first year of diagnosis. Half the patients presented with localized and half with diffuse lymphadenopathy. It was generally associated with other systemic lupus symptoms and serological activity. 2/3 of the patients were biopsied and only one patient had non-hodgkin's lymphoma. The others had either reactive or necrotizing lymphadenitis consistent with lupus lymphadenitis (Graef et al...