Differential Diagnosis for 58 YOF with Enlarged Lymph Nodes in the Left Axilla

• Single Most Likely Diagnosis
  • Breast Abscess or Infected Breast Cyst: The patient's symptoms of painful, red, and enlarged lymph nodes in the axilla, along with a history of a moderate-sized lump that resolved and was followed by multiple smaller lumps, suggest a localized infection. The presence of nausea, emesis, and significant pain further supports an infectious process. Given the location and the patient's gender, an infected breast cyst or abscess is a plausible explanation.
• Other Likely Diagnoses
  • Lymphadenitis: Inflammation of the lymph nodes due to infection, which could be bacterial, viral, or fungal. The painful and enlarged lymph nodes are consistent with this diagnosis.
  • Cat Scratch Disease: Although less common, this disease caused by Bartonella henselae can lead to lymphadenopathy, especially if the patient has been exposed to cats.
  • Breast Cancer with Secondary Infection: While less likely given the acute presentation, it's essential to consider breast cancer, especially if there's a palpable mass or other suspicious findings on examination.
• Do Not Miss Diagnoses
  • Lymphoma: A type of cancer that begins in cells of the lymph system, which could present with lymphadenopathy. It's crucial to consider this diagnosis due to its significant implications for treatment and prognosis.
  • Metastatic Cancer: Cancer that has spread from another part of the body to the lymph nodes in the axilla. Given the patient's age, it's essential to rule out metastatic disease, especially if there's a known history of cancer.
  • Tuberculosis or Other Granulomatous Disease: Although less common in some regions, tuberculosis can cause lymphadenopathy and must be considered, especially in patients with risk factors or exposure history.
• Rare Diagnoses
  • Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, typically in young women. It's characterized by painful lymph nodes, often accompanied by fever and night sweats.
  • Kimura Disease: A rare, chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia, more commonly seen in Asian males but can occur in females.
  • Castleman Disease: A rare disorder that involves an overgrowth of cells in the lymphatic system, which can cause lymphadenopathy among other symptoms.

Each of these diagnoses should be considered in the context of the patient's full clinical presentation, including history, physical examination, laboratory tests, and imaging studies as appropriate.