Differential Diagnosis for Seizures and Non-Caseating Granulomas on Lymph Node Biopsy
Single Most Likely Diagnosis
- Sarcoidosis: This condition is known for causing non-caseating granulomas in lymph nodes and can also affect the nervous system, leading to seizures. The presence of seizures and non-caseating granulomas makes sarcoidosis a strong candidate for the diagnosis.
Other Likely Diagnoses
- Lymphoma: Certain types of lymphoma, such as Hodgkin lymphoma, can present with non-caseating granulomas. Seizures can occur due to CNS involvement or paraneoplastic syndromes. Although less common, lymphoma should be considered in the differential diagnosis.
- Tuberculosis: While caseating granulomas are more typical of tuberculosis, non-caseating granulomas can also be seen, especially in atypical presentations. CNS tuberculosis can cause seizures, making this a plausible diagnosis.
- Histoplasmosis: This fungal infection can cause non-caseating granulomas and, in rare cases, CNS involvement leading to seizures. It's more likely in endemic areas or in immunocompromised patients.
Do Not Miss Diagnoses
- Neurosarcoidosis with CNS involvement: Even though sarcoidosis is already considered, emphasizing its CNS involvement is crucial due to the potential for severe neurological complications, including seizures. Missing this diagnosis could lead to inadequate treatment and poor outcomes.
- CNS Lymphoma: Primary CNS lymphoma or secondary involvement can cause seizures and should not be overlooked due to its aggressive nature and the need for prompt treatment.
- Infectious causes like Toxoplasmosis or Cysticercosis: In immunocompromised patients, these infections can cause seizures and granulomatous reactions. Missing these diagnoses could be fatal, especially if left untreated.
Rare Diagnoses
- Granulomatosis with Polyangiitis (GPA): Formerly known as Wegener's granulomatosis, GPA can cause granulomatous inflammation and, in rare cases, CNS symptoms including seizures. It's a rare condition but should be considered in the differential due to its potential for severe morbidity.
- Erdheim-Chester Disease: A rare form of histiocytosis that can cause granulomatous lesions and, in some cases, CNS involvement leading to seizures. Its rarity makes it a less likely diagnosis, but it should be kept in mind for patients with atypical presentations.
- Berylliosis (Chronic Beryllium Disease): This occupational disease can cause granulomatous inflammation similar to sarcoidosis and, in rare instances, may affect the CNS. It's an important consideration in patients with a relevant occupational history.