Differential Diagnosis
The patient's symptoms of generalized lymphadenopathy, intermittent low-grade fever, and a cystic lesion in the spleen can be attributed to various conditions. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Tuberculosis (TB): TB can cause generalized lymphadenopathy, low-grade fever, and splenic lesions. The presence of these symptoms, especially in endemic areas, makes TB a strong candidate for the diagnosis.
- Other Likely diagnoses
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can present with generalized lymphadenopathy and systemic symptoms like low-grade fever. Splenic involvement is also common in lymphoma.
- Sarcoidosis: This condition can cause lymphadenopathy and systemic symptoms. Although less common, sarcoidosis can also involve the spleen.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Kala azar (Visceral Leishmaniasis): Although less common in some areas, kala azar can present with similar symptoms, including lymphadenopathy, fever, and splenomegaly. It's crucial to consider this diagnosis due to its high mortality rate if left untreated.
- Malaria: Certain types of malaria, especially those caused by Plasmodium vivax or Plasmodium ovale, can have a more prolonged course with intermittent symptoms. Splenic rupture is a rare but life-threatening complication.
- Rare diagnoses
- Castleman disease: A rare condition that can cause lymphadenopathy and systemic symptoms. It's often associated with human herpesvirus 8 (HHV-8) infection.
- Brucellosis: A zoonotic infection that can cause fever, lymphadenopathy, and splenomegaly. It's more common in individuals who work with animals or consume unpasteurized dairy products.
- Histoplasmosis: A fungal infection that can cause lymphadenopathy, fever, and splenomegaly, especially in immunocompromised individuals.