Differential Diagnosis for Patient with Generalized Lymphadenopathy, Intermittent Low-Grade Fever, and Cystic Spleen Lesion

• Single Most Likely Diagnosis
  • Tuberculosis (C): This is the most likely diagnosis given the combination of generalized lymphadenopathy, intermittent low-grade fever, and the presence of a cystic lesion in the spleen. Tuberculosis can affect multiple systems in the body, including the lymphatic system, and splenic involvement, although less common, can occur, especially in the form of tuberculous abscesses or granulomas that might appear as cystic lesions on imaging.
• 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 common in lymphoma, and while cystic lesions are less typical, they can occur, especially in the context of lymphomatous infiltration.
  • Sarcoidosis: This condition can cause generalized lymphadenopathy and may involve the spleen, although splenic cysts are not a typical feature. However, the systemic nature of the disease, including fever, makes it a consideration.
• Do Not Miss Diagnoses
  • Kala Azar (A): Also known as visceral leishmaniasis, this disease can cause significant systemic symptoms, including fever and splenomegaly. While lymphadenopathy is less common, the disease's severity and the fact that it can involve the spleen (potentially leading to cystic changes due to necrosis or other complications) make it crucial not to miss.
  • Malaria (B): Certain types of malaria, especially those caused by Plasmodium vivax and Plasmodium ovale, can lead to splenic enlargement and, in rare cases, rupture. The intermittent fever pattern can be reminiscent of malaria, especially in endemic areas.
• Rare Diagnoses
  • Castleman Disease: A rare disorder that can cause lymphadenopathy and systemic symptoms, including fever. It can involve the spleen, although cystic lesions would be an unusual presentation.
  • Brucellosis: This zoonotic infection can cause a wide range of symptoms, including fever, lymphadenopathy, and splenomegaly. While less common, it could potentially lead to cystic changes in the spleen due to abscess formation.
  • Histoplasmosis: A fungal infection that can cause lymphadenopathy, fever, and splenic involvement, particularly in immunocompromised individuals. Cystic lesions in the spleen could occur due to caseating granulomas.