Differential Diagnosis for 2 Weeks of Fever, Diffuse Lymphadenopathy, Fever and Diaphoresis with Significant Weight Loss and Hepatomegaly
Single Most Likely Diagnosis
- Lymphoma: Given the combination of diffuse lymphadenopathy, significant weight loss, fever, diaphoresis (night sweats), and hepatomegaly, lymphoma (either Hodgkin or non-Hodgkin) is a leading consideration. These symptoms are classic for lymphoma, particularly the presence of systemic symptoms (B symptoms: weight loss, fever, night sweats).
Other Likely Diagnoses
- Tuberculosis (TB): TB can cause a similar constellation of symptoms, including fever, night sweats, weight loss, and lymphadenopathy. Hepatomegaly can also occur, especially in disseminated TB.
- HIV Infection: Acute HIV infection can present with fever, lymphadenopathy, and systemic symptoms. Hepatomegaly may be present due to the infection itself or due to opportunistic infections.
- Mononucleosis (Infectious Mononucleosis): Caused by Epstein-Barr virus (EBV), this condition can lead to fever, lymphadenopathy, and hepatomegaly. Although weight loss and diaphoresis are less common, they can occur.
Do Not Miss Diagnoses
- Leukemia: Both acute and chronic leukemias can present with systemic symptoms, lymphadenopathy, and hepatomegaly. It's crucial to consider leukemia due to its aggressive nature and the need for prompt treatment.
- Sepsis or Disseminated Infection: Although less likely given the chronic nature of the symptoms, a disseminated infection (e.g., endocarditis, osteomyelitis) could present with similar findings and is critical not to miss due to its high mortality if untreated.
- Autoimmune Lymphoproliferative Syndrome (ALPS): A rare condition that can mimic lymphoma but is essential to diagnose due to its different management and prognosis.
Rare Diagnoses
- Castleman Disease: A rare disorder that can cause lymphadenopathy, fever, weight loss, and hepatomegaly. It can be unicentric or multicentric, with the latter often associated with more systemic symptoms.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, fever, and night sweats, more commonly seen in young women.
- Histiocytosis: A group of rare diseases involving abnormal proliferation of histiocytes, which can lead to lymphadenopathy, hepatomegaly, and systemic symptoms.