Differential Diagnosis for Lymphadenopathy in the Neck with Splenomegaly
Single Most Likely Diagnosis
- Lymphoma: This is often the first consideration due to the combination of lymphadenopathy and splenomegaly, which are common manifestations of lymphoma. Both Hodgkin lymphoma and non-Hodgkin lymphoma can present with these symptoms.
Other Likely Diagnoses
- Chronic Lymphocytic Leukemia (CLL): CLL can cause both lymphadenopathy and splenomegaly due to the accumulation of malignant lymphocytes in these organs.
- Infectious Mononucleosis: Caused by Epstein-Barr virus (EBV), this condition can lead to lymphadenopathy, splenomegaly, and even hepatomegaly.
- Tuberculosis: Although more commonly associated with pulmonary symptoms, extrapulmonary tuberculosis can cause lymphadenopathy and, less commonly, splenomegaly.
- HIV Infection: HIV can lead to persistent generalized lymphadenopathy and splenomegaly, especially in the absence of antiretroviral therapy.
Do Not Miss Diagnoses
- Hodgkin Lymphoma with Sarcoidosis: While sarcoidosis itself is less likely to cause significant splenomegaly, it can cause lymphadenopathy and should be considered, especially if there are other systemic symptoms.
- Systemic Lupus Erythematosus (SLE): SLE can cause both lymphadenopathy and splenomegaly, along with a myriad of other systemic symptoms. Missing this diagnosis could lead to significant morbidity.
- Castleman Disease: A rare disorder that can cause lymphadenopathy and splenomegaly, often with systemic symptoms. It's crucial not to miss this diagnosis due to its potential for significant morbidity and the availability of specific treatments.
Rare Diagnoses
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, often with fever and night sweats. Splenomegaly is less common but can occur.
- Rosai-Dorfman Disease: A rare histiocytic disorder that can cause lymphadenopathy and, less commonly, splenomegaly, along with other systemic symptoms.
- Langerhans Cell Histiocytosis: Although more commonly associated with bone lesions, this condition can also cause lymphadenopathy and splenomegaly in some cases.
- Malignant Histiocytosis: A rare and aggressive condition that can cause both lymphadenopathy and splenomegaly, often with systemic symptoms and a poor prognosis.