Differential Diagnosis for Patient with Anemia and Lymph Node Enlargement

The patient presents with anemia (Hb 7.4) and two palpable lumps, one in the left axilla and the other in the right infrascapular region, both measuring 2 by 2 cm and described as painless and movable. Given these findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Lymphoma: This is a strong consideration given the presence of anemia and multiple lymph node enlargements in different regions. Lymphoma can cause anemia due to bone marrow involvement or as a paraneoplastic syndrome. The lymph nodes are often painless and movable, fitting the patient's presentation.

• Other Likely Diagnoses

  • Chronic Lymphocytic Leukemia (CLL): CLL can present with lymphadenopathy and anemia. The disease often has a indolent course, and patients may be asymptomatic for a long time, with lymph nodes being painless and movable.
  • Tuberculosis (TB): Although TB can cause anemia and lymphadenopathy, the lymph nodes are more commonly found in the cervical or supraclavicular regions. However, it's a consideration, especially in endemic areas or in patients with risk factors.
  • Metastatic Cancer: Certain cancers, like breast cancer, can metastasize to the axillary lymph nodes, and other cancers can spread to the infrascapular region. Anemia could be a result of the primary cancer or its treatment.

• Do Not Miss Diagnoses

  • Hodgkin Lymphoma: Although less common than non-Hodgkin lymphoma, Hodgkin lymphoma can present with lymphadenopathy and systemic symptoms, including anemia. It's crucial to diagnose early due to its potential for cure with appropriate treatment.
  • Sarcoidosis: This condition can cause lymphadenopathy and anemia due to granulomatous infiltration of the bone marrow. It's less likely but important not to miss due to its systemic implications and the availability of treatment.

• Rare Diagnoses

  • Castleman Disease: A rare disorder that can cause lymphadenopathy and anemia. It's characterized by overgrowth of cells in the lymphatic system and can be associated with systemic symptoms.
  • Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, often in the cervical region, but can be found in other areas. It's more common in young women and can be associated with systemic symptoms, including anemia.

Each of these diagnoses requires further investigation, including imaging studies (e.g., CT scans), blood tests (e.g., complete blood count, blood smear, and specific markers for lymphoma or leukemia), and potentially a lymph node biopsy to establish a definitive diagnosis.