Differential Diagnosis
- Single most likely diagnosis
- Hormonal fluctuations related to PCOS: The patient's symptoms of swollen and tender lymph nodes, particularly under the arms, seem to be related to their menstrual cycle, and the use of flutamide, a DHT blocker, has helped with PCOS symptoms. This suggests that hormonal fluctuations are likely contributing to the patient's lymph node symptoms.
- Other Likely diagnoses
- Fibrocystic changes: The patient's symptoms of swollen and tender lymph nodes, particularly under the arms, could be related to fibrocystic changes, which are common in women with PCOS.
- Recurrent viral infections: The patient's initial presentation of a red rash on the voice box area with fever and swollen lymph nodes could be indicative of a viral infection, and the recurrent swelling of lymph nodes could be related to recurrent viral infections.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma: Although the patient's symptoms have been chronic and seem to be related to their menstrual cycle, lymphoma is a potentially life-threatening condition that should not be missed. A thorough evaluation, including imaging and potentially a biopsy, may be necessary to rule out lymphoma.
- Tuberculosis: The patient's initial presentation of a red rash on the voice box area with fever and swollen lymph nodes could be indicative of tuberculosis, which is a serious and potentially life-threatening condition if left untreated.
- Rare diagnoses
- Kikuchi-Fujimoto disease: This is a rare condition characterized by recurrent lymphadenitis, often accompanied by fever and rash. Although it is rare, it could be considered in the differential diagnosis, particularly given the patient's initial presentation.
- Castleman disease: This is a rare condition characterized by lymphadenopathy, often accompanied by systemic symptoms such as fever and weight loss. Although it is rare, it could be considered in the differential diagnosis, particularly if the patient's symptoms persist or worsen over time.