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Differential Diagnosis for a 10-year-old Female with a Neck Lump

Single Most Likely Diagnosis

  • Infectious Mononucleosis (Mono): Given the patient's overall not feeling well, tender neck, and the presence of + EBV antibodies, infectious mononucleosis is a strong consideration. The mildly enlarged lymph nodes and the clinical presentation are consistent with this diagnosis.

Other Likely Diagnoses

  • Reactive Lymphadenopathy: The MRI findings of multiple bilateral jugular chain lymph nodes that are more notable for number rather than size, along with a few mildly enlarged nodes, could be indicative of a reactive process. This is often seen in response to viral infections or other benign conditions.
  • Viral Pharyngitis: The patient's symptoms of a tender neck and not feeling well could also be consistent with viral pharyngitis, which can cause lymphadenopathy.

Do Not Miss Diagnoses

  • Lymphoma: Although the MRI findings are favored to be benign/reactive, malignant adenopathy, such as lymphoma, could present similarly. It is crucial to follow up clinically to document stability or changes in the lymph nodes.
  • Tuberculosis (TB): TB can cause lymphadenopathy and systemic symptoms. Although less common in this demographic, it is a critical diagnosis not to miss due to its potential severity and the need for specific treatment.
  • Hodgkin Lymphoma: This is another malignancy that could present with lymphadenopathy. Given the patient's age and symptoms, it is essential to consider and rule out this diagnosis.

Rare Diagnoses

  • Castleman Disease: A rare disorder that involves an overgrowth of cells in the lymph nodes, which can cause lymphadenopathy and systemic symptoms.
  • Kikuchi-Fujimoto Disease: A rare, self-limiting condition that can cause lymphadenopathy, often accompanied by fever and night sweats.
  • Sarcoidosis: Although rare in children, sarcoidosis can cause lymphadenopathy and should be considered in the differential diagnosis, especially if other systemic symptoms are present.

Professional Medical Disclaimer

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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