Differential Diagnosis for Tender Submandibular Lymphadenopathy

Single Most Likely Diagnosis

• Viral Pharyngitis: This is often the most common cause of tender submandibular lymphadenopathy, especially in the context of a recent upper respiratory infection. The lymphadenopathy is typically reactive, meaning it's a response to an infection rather than a primary disease of the lymph nodes themselves.

Other Likely Diagnoses

• Bacterial Pharyngitis: Caused by Group A beta-hemolytic streptococcus, this condition can also lead to tender lymphadenopathy in the submandibular region. The presence of a sore throat, fever, and absence of cough can help differentiate it from viral causes.
• Dental Infections: Infections of the teeth or gums can cause lymphadenopathy in the submandibular region due to the drainage of the facial lymphatics. Dental infections are a common cause of localized lymph node enlargement and tenderness.
• Mononucleosis: Caused by Epstein-Barr virus, this condition can lead to lymphadenopathy, including in the submandibular region, along with fever, sore throat, and fatigue.

Do Not Miss Diagnoses

• Lymphoma: Although less common, lymphoma can present with lymphadenopathy, including in the submandibular region. It's crucial to consider this diagnosis, especially in the absence of an obvious infectious cause or if the lymphadenopathy persists or grows over time.
• Tuberculosis: TB can cause lymphadenitis, which may present as tender lymphadenopathy. This diagnosis is particularly important to consider in individuals with risk factors for TB exposure or in areas where TB is prevalent.
• Cat-Scratch Disease: Caused by Bartonella henselae, this condition can lead to tender lymphadenopathy, typically following a cat scratch or bite. It's an important diagnosis to consider in patients with a history of cat exposure.

Rare Diagnoses

• Kikuchi-Fujimoto Disease: A rare, self-limiting condition that can cause lymphadenopathy, including in the submandibular region, along with fever and night sweats. It's more common in young women and of Asian descent.
• Kimura Disease: A chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia. It's rare and more commonly seen in Asian males.
• Sarcoidosis: Although more commonly associated with pulmonary symptoms, sarcoidosis can cause lymphadenopathy, including in the submandibular region, as part of its systemic manifestations.