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 and the presence of pain, lymphoma is a strong consideration. The involvement of multiple lymph node groups (cervical and possibly axillary given the shoulder and elbow symptoms) further supports this diagnosis.
- Other Likely Diagnoses
- Rheumatoid Arthritis (RA): The patient's symptoms of joint pain, swelling, and stiffness, particularly in the elbows and wrists, could suggest RA. However, the prominent lymphadenopathy is less typical for RA.
- 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.
- Do Not Miss Diagnoses
- Metastatic Cancer: Although less likely given the gradual onset, it's crucial not to miss the possibility of metastatic cancer to the lymph nodes, which could explain the lymphadenopathy and pain.
- Tuberculosis (TB): TB can cause lymphadenopathy and systemic symptoms. Given its potential severity and the need for specific treatment, it's a diagnosis that should not be overlooked.
- Rare Diagnoses
- Sarcoidosis: This condition can cause lymphadenopathy and joint symptoms but is less common and would typically be associated with other systemic symptoms such as lung involvement.
- Castleman Disease: A rare disorder that involves an overgrowth of cells in the lymphatic system, which could explain the lymphadenopathy but is much less common than other diagnoses listed here.
Each diagnosis is considered based on the combination of lymph node swelling, specific patterns of pain, and associated neurological symptoms, with an emphasis on not missing potentially life-threatening conditions.