Differential Diagnosis
The patient presents with a combination of symptoms including fullness under the left ribs, palpable neck and elbow lymph nodes, and muscle tension in the left shoulder. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Chronic Lymphocytic Leukemia (CLL) or Lymphoma: The presence of palpable lymph nodes in multiple regions (neck and elbow) along with prolonged symptoms of fullness under the ribs, which could be indicative of splenomegaly, points towards a lymphoproliferative disorder. CLL and lymphoma are common causes of such presentations.
Other Likely diagnoses
- Hodgkin Lymphoma: Similar to CLL, Hodgkin lymphoma can present with lymphadenopathy and systemic symptoms. The presence of lymph nodes in the neck and other areas makes this a plausible diagnosis.
- Mononucleosis (Infectious): Caused by Epstein-Barr virus, it can lead to prolonged lymphadenopathy and splenomegaly, which might explain the fullness under the ribs.
- Autoimmune Disorders (e.g., Rheumatoid Arthritis, Lupus): These conditions can cause lymphadenopathy and systemic symptoms, including muscle tension and joint issues, which might explain the knots in the shoulder.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Tuberculosis: Although less common in some regions, TB can cause lymphadenopathy, systemic symptoms, and can affect various parts of the body. It's crucial to consider, especially if the patient has been exposed or has risk factors.
- Metastatic Cancer: Certain cancers, like lung or breast cancer, can metastasize to lymph nodes and cause systemic symptoms. Given the duration of symptoms, it's essential to rule out malignancy.
- HIV/AIDS: Infection with HIV can lead to persistent generalized lymphadenopathy and increase the risk of opportunistic infections and cancers.
Rare diagnoses
- Castleman Disease: A rare disorder that involves an overgrowth of cells in the body's lymph nodes, which can cause lymphadenopathy and systemic symptoms.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, usually in the neck, and can be accompanied by systemic symptoms.
- Sarcoidosis: Although more commonly associated with lung and skin manifestations, sarcoidosis can cause lymphadenopathy and might be considered in the differential diagnosis, especially if other systemic symptoms are present.
Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic tests to determine the most appropriate diagnosis and treatment plan.