Differential Diagnosis

The patient's symptoms of swollen tonsils with a white patch, lymphadenopathy of neck nodes, and subsequent resolution with antibiotic treatment, followed by swelling around previously enlarged lymph nodes, warrant a comprehensive differential diagnosis. The following categories outline potential causes:

• Single Most Likely Diagnosis
  • Infectious Mononucleosis (Mono): This condition, caused by Epstein-Barr virus (EBV), often presents with sore throat, fever, lymphadenopathy, and fatigue. The resolution of tonsillar swelling and decrease in lymphadenopathy after antibiotic treatment could be coincidental, as mono is typically self-limiting. The hard swelling around previously enlarged lymph nodes could be reactive lymphadenopathy, a common finding in infectious mononucleosis.
• Other Likely Diagnoses
  • Reactive Lymphadenitis: This is an inflammatory response to infection or other stimuli, which could explain the lymphadenopathy and its resolution. The hard swelling around lymph nodes could be due to fibrosis or residual inflammation.
  • Tuberculosis (TB): Although less common, TB can cause lymphadenopathy, and the hard swelling around lymph nodes could be indicative of tuberculous lymphadenitis. The resolution of symptoms with antibiotic treatment does not rule out TB, as some antibiotics may have partial efficacy against TB.
• Do Not Miss Diagnoses
  • Lymphoma: Although the pattern of symptoms and response to treatment might not strongly suggest lymphoma, it is crucial not to miss this diagnosis due to its significant implications. The hard swelling around previously enlarged lymph nodes could potentially be a sign of lymphomatous involvement.
  • Hodgkin Lymphoma: This type of lymphoma often presents with lymphadenopathy, and the symptoms could fit, especially if the lymphadenopathy was significant and the hard swelling represents residual disease or fibrosis.
• Rare Diagnoses
  • Sarcoidosis: This autoimmune condition can cause lymphadenopathy and might result in hard, non-tender lymph nodes. However, it is less likely given the acute presentation and response to antibiotic treatment.
  • Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, often accompanied by fever and night sweats. The hard swelling around lymph nodes could be part of the disease process, but this diagnosis is less common and might not fit as well with the initial response to antibiotics.

Each of these diagnoses has a different set of implications for treatment and prognosis, emphasizing the importance of a thorough diagnostic workup to determine the underlying cause of the patient's symptoms.