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Differential Diagnosis for a 10-year-old Female with Tender Posterior Cervical Lymph Node and LUQ Pain

  • Single most likely diagnosis:
    • Cat-scratch disease: This is a common condition in children, caused by Bartonella henselae, typically presenting with a tender lymph node near the site of a cat scratch or bite, which could explain the tender posterior cervical lymph node. The LUQ pain could be referred pain or unrelated, but given the lack of other symptoms like fever or abdominal pain, and a normal CBC, this diagnosis is plausible.
  • Other Likely diagnoses:
    • Infectious mononucleosis (Mono): Although the patient denies sore throat and fever, mono can present with lymphadenopathy and sometimes abdominal pain due to splenomegaly, which could explain the LUQ pain. A normal CBC does not rule out mono, as the diagnosis is often made based on clinical presentation and specific mono spot test or EBV titers.
    • Tuberculosis (TB): TB can cause lymphadenopathy and, less commonly, abdominal symptoms if there is gastrointestinal involvement. However, TB is less likely without systemic symptoms like fever, weight loss, or a known exposure history.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
    • Lymphoma: Although rare in children, lymphoma can present with lymphadenopathy and systemic symptoms. The absence of fever, night sweats, or significant weight loss makes this less likely, but it's crucial to consider due to its severity and the need for early diagnosis.
    • Neuroblastoma: This is a rare pediatric cancer that can present with lymphadenopathy and abdominal masses, which might cause LUQ pain if the mass is large enough. It's essential to consider, especially given the location of the pain and the lymph node involvement.
  • Rare diagnoses:
    • Kawasaki disease: Typically presents with fever, rash, conjunctivitis, and changes to the lips and oral cavity, along with lymphadenopathy. Without these characteristic symptoms, it's less likely, but it's a rare condition that could have atypical presentations.
    • Histiocytosis: A group of rare diseases involving abnormal proliferation of histiocytes, which can cause lymphadenopathy and systemic symptoms. It's rare and would be considered if other diagnoses are ruled out and the condition progresses or worsens.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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