Differential Diagnosis for Supraclavicular Lymph Node Necrotizing Granuloma with Pulmonary Nodules and Multiple Liver Lesions Negative Quantiferon
- Single Most Likely Diagnosis
- Sarcoidosis: This condition is characterized by the formation of granulomas in various parts of the body, including the lungs, liver, and lymph nodes. The presence of necrotizing granulomas in a supraclavicular lymph node, along with pulmonary nodules and liver lesions, could be indicative of sarcoidosis, especially given the negative Quantiferon test which makes tuberculosis less likely.
- Other Likely Diagnoses
- Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can present with lymphadenopathy, including supraclavicular lymph nodes, and may involve other organs such as the liver and lungs. The presence of necrotizing granulomas could be seen in certain types of lymphoma.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): This is a form of vasculitis that can affect multiple organs, including the lungs and kidneys, and can present with granulomatous inflammation. Although it more commonly affects the upper respiratory tract and kidneys, it could potentially explain the findings.
- Do Not Miss Diagnoses
- Tuberculosis (TB): Despite the negative Quantiferon test, TB cannot be entirely ruled out, especially in endemic areas or in immunocompromised patients. TB can cause granulomatous inflammation in lymph nodes, lungs, and other organs. A negative test does not exclude TB, particularly if the patient is severely immunocompromised.
- Histoplasmosis: This fungal infection can cause granulomatous disease affecting the lungs, liver, and lymph nodes. It's particularly relevant in endemic areas and can be life-threatening if not treated.
- Rare Diagnoses
- Cat-Scratch Disease (Bartonellosis): Caused by Bartonella henselae, this disease can lead to lymphadenopathy, often with a history of cat scratch or bite. While it typically presents with more localized symptoms, disseminated disease could potentially explain the findings in rare cases.
- Brucellosis: A zoonotic infection that can cause granulomatous disease in various organs, including the liver and lymph nodes. It's rare but should be considered in individuals with exposure to infected animals or their products.