Differential Diagnosis
The patient's symptoms of lymphadenopathy, jaw pain, stiffness, swelling, ear pain, and dullness in the right ear, which recurred after initial treatment with doxycycline and steroids, suggest a complex condition. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Temporomandibular joint (TMJ) disorder or temporomandibular dysfunction: The symptoms of jaw pain, stiffness, and swelling, along with ear pain, are classic for TMJ disorders. The initial response to steroids suggests an inflammatory component, which is common in TMJ disorders.
- Other Likely diagnoses
- Lymphoma: Given the initial presentation of lymphadenopathy in the right neck, lymphoma is a consideration, especially since the symptoms recurred after treatment. The jaw and ear symptoms could be related to lymph node involvement or compression effects.
- Osteomyelitis or dental infection: Infections in the jaw or dental structures can cause pain, swelling, and stiffness, and could potentially explain the ear symptoms due to referred pain. The lack of response to doxycycline might suggest a more complex infection.
- Sialadenitis: Inflammation of the salivary glands, which could be caused by infection or autoimmune conditions, might explain some of the symptoms, especially if the parotid gland is involved, given its proximity to the ear and jaw.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant otitis externa: Although more common in diabetic or immunocompromised patients, this condition can lead to severe complications, including cranial nerve palsies and death, if not promptly treated.
- Parotid gland malignancy: Any mass or persistent swelling in the parotid gland area warrants thorough investigation for malignancy, given the potential for serious outcomes if left untreated.
- Giant Cell Arteritis: This condition can cause jaw claudication and ear symptoms, among others, and is a medical emergency due to the risk of vision loss if not promptly treated.
- Rare diagnoses
- Relapsing polychondritis: An autoimmune condition that can cause cartilage inflammation, leading to symptoms like ear pain and swelling, but it's relatively rare.
- Eagle syndrome: Characterized by an elongated styloid process or calcified stylohyoid ligament, which can cause ear pain, facial pain, and dysphagia, but it's not commonly encountered.
- Kimura disease: A rare, chronic inflammatory disorder that can cause lymphadenopathy and salivary gland swelling, typically presenting with eosinophilia and IgE elevation.