Differential Diagnosis for 31-year-old Patient
The patient presents with a range of symptoms including a feeling of fullness under the left ribs, palpable lymph nodes in the left armpit and elbow, night sweats, extreme anxiety, and IBS-type symptoms. Here is a differential diagnosis organized into categories:
Single Most Likely Diagnosis
- Lymphoma: This could explain the palpable lymph nodes, night sweats, and feeling of fullness under the ribs due to possible splenomegaly. Anxiety and IBS-type symptoms can also be associated with lymphoma due to either the disease process itself or the psychological impact of dealing with a serious illness.
Other Likely Diagnoses
- Mononucleosis (Infectious Mononucleosis): Caused by Epstein-Barr virus, it can lead to lymphadenopathy, splenomegaly (causing fullness under the ribs), and systemic symptoms like night sweats. Anxiety and gastrointestinal symptoms can also occur.
- Tuberculosis: Although less common in some regions, TB can cause lymphadenopathy, night sweats, and systemic symptoms. It can also lead to anxiety and gastrointestinal symptoms.
- Hodgkin Lymphoma: Similar to lymphoma, Hodgkin lymphoma can present with lymphadenopathy, night sweats, and systemic symptoms. The presence of lymph nodes in the armpit and elbow, along with other symptoms, makes this a consideration.
Do Not Miss Diagnoses
- Leukemia: Leukemias, especially chronic lymphocytic leukemia (CLL) or acute lymphoblastic leukemia (ALL), can present with lymphadenopathy, splenomegaly, and systemic symptoms. Night sweats and anxiety can also be part of the clinical picture.
- Lymph Node Metastasis from an Underlying Cancer: Although less likely in a 31-year-old without a known primary cancer, it's crucial not to miss metastatic disease, especially if the lymph nodes are significantly enlarged or hard.
- Sarcoidosis: This autoimmune disease can cause lymphadenopathy, systemic symptoms, and can affect various organs, potentially explaining some of the patient's symptoms.
Rare Diagnoses
- Castleman Disease: A rare disorder that involves an overgrowth of cells in the body's lymph nodes. It can cause lymphadenopathy, systemic symptoms like night sweats, and potentially explain the feeling of fullness under the ribs.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that can cause lymphadenopathy, fever, and night sweats, primarily affecting young women.
- Brucellosis: A zoonotic infection that can cause systemic symptoms including fever, night sweats, and lymphadenopathy, though it's less common and typically associated with exposure to infected animals or their products.