Differential Diagnosis for Lymphadenopathy in the Neck with Enlarged Spleen
Single Most Likely Diagnosis
- Lymphoma: This is a common cause of both lymphadenopathy and splenomegaly. Lymphoma can involve any lymph node group, including those in the neck, and often presents with systemic symptoms such as fever, weight loss, and fatigue. The spleen can become enlarged due to lymphomatous infiltration.
Other Likely Diagnoses
- Chronic Lymphocytic Leukemia (CLL): CLL is a type of leukemia that can cause both lymphadenopathy and splenomegaly. It often presents in older adults and can be asymptomatic for a long time.
- Infectious Mononucleosis: Caused by Epstein-Barr virus (EBV), this condition can lead to lymphadenopathy, particularly in the neck, and splenomegaly. It is more common in younger individuals.
- Tuberculosis: Although more commonly associated with pulmonary symptoms, tuberculosis can cause lymphadenopathy and, less commonly, splenomegaly, especially in immunocompromised patients or those with disseminated disease.
- Hodgkin Lymphoma: Similar to non-Hodgkin lymphoma, Hodgkin lymphoma can cause lymphadenopathy, often starting in the neck, and can also lead to splenomegaly.
Do Not Miss Diagnoses
- HIV Infection: HIV can cause lymphadenopathy and splenomegaly, particularly in the acute phase of the infection. It's crucial to consider HIV in the differential diagnosis due to its significant implications for treatment and prognosis.
- Systemic Lupus Erythematosus (SLE): SLE is an autoimmune disease that can cause a wide range of symptoms, including lymphadenopathy and splenomegaly. It's essential to consider SLE due to its potential for serious complications if left untreated.
- Cat-Scratch Disease: Caused by Bartonella henselae, this infection can lead to lymphadenopathy, typically in the neck, and, although less common, can cause splenomegaly.
Rare Diagnoses
- Castleman Disease: A rare disorder that can cause lymphadenopathy and splenomegaly. It can be unicentric (localized) or multicentric (systemic), with the latter form often associated with more severe symptoms and systemic involvement.
- Sarcoidosis: Although more commonly associated with pulmonary symptoms, sarcoidosis can cause lymphadenopathy and, less frequently, splenomegaly. It is characterized by the formation of granulomas in various organs.
- Brucellosis: A zoonotic infection that can cause lymphadenopathy, splenomegaly, and systemic symptoms. It's rare in many parts of the world but should be considered in individuals with exposure to infected animals or their products.