History of Present Illness (HPI)
The patient is a [insert age]-year-old [insert sex] who presents with a 3-month history of swelling in the lymph nodes, primarily in the left shoulder and elbow, accompanied by pain. The pain, described as intermittent, throbbing, and radiating to the wrist, started 4 months ago. The patient rates the pain as 2/10 at its lowest and 6/10 at its peak, with associated slight numbness and tingling. Additionally, the patient reports slight swelling in the cervical lymph nodes.
Differential Diagnosis
Single Most Likely Diagnosis
- Lymphoma: Given the gradual onset of lymph node swelling over months, lymphoma is a strong consideration. The involvement of multiple lymph node groups (cervical and possibly axillary given the shoulder and elbow symptoms) and the presence of systemic symptoms like pain and neurological symptoms (numbness and tingling) can be indicative of lymphoma.
Other Likely Diagnoses
- Rheumatoid Arthritis (RA): The patient's symptoms of joint pain, swelling, and morning stiffness (though not explicitly mentioned, it can be inferred from the description of pain and swelling) could suggest RA, especially if there's evidence of symmetric joint involvement and positive serological tests.
- Brachial Plexus Neuropathy: The radiation of pain to the wrist and the presence of numbness and tingling could indicate a neuropathic origin, such as brachial plexus neuropathy, which might be idiopathic or secondary to another condition.
- Metastatic Cancer: If the patient has a known history of cancer, metastasis to the lymph nodes could explain the swelling and pain, especially if the primary cancer is known to metastasize to these areas.
Do Not Miss Diagnoses
- Tuberculosis (TB): Although less common in some regions, TB can cause lymphadenopathy and systemic symptoms. It's crucial to consider TB, especially if the patient has been exposed or has risk factors.
- Hodgkin Lymphoma: Similar to non-Hodgkin lymphoma, Hodgkin lymphoma can present with lymphadenopathy, but it often has a more predictable pattern of spread and may be associated with systemic symptoms like fever, night sweats, and weight loss.
- Sarcoidosis: This condition can cause lymphadenopathy and may also involve other organs, leading to a wide range of symptoms. It's less likely but important not to miss due to its potential for significant morbidity.
Rare Diagnoses
- Castleman Disease: A rare disorder that involves an overgrowth of cells in the lymphatic system, which can cause lymphadenopathy, fever, and other systemic symptoms.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, typically in the cervical region, and can be accompanied by fever and other systemic symptoms.
- Kimura Disease: A rare, chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia, often presenting with subcutaneous nodules in the head and neck region.