Differential Diagnosis for Lymphadenopathy
- Single most likely diagnosis
- B. Epstein-Barr virus infection (41%): The patient's symptoms of sore throat, malaise, and lymphadenopathy, particularly with the history of similar episodes, could suggest a chronic or recurrent infection. Epstein-Barr virus (EBV) infection, which causes infectious mononucleosis, can present with these symptoms and is known for causing lymphadenopathy. The fact that the patient's symptoms and lymph node size fluctuate and improve without specific treatment also aligns with the natural history of EBV infection.
- Other Likely diagnoses
- E. Recurrent group A streptococcal infection (15%): This could be a consideration given the patient's history of recurrent sore throat and lymphadenopathy. However, the absence of fever, chills, and difficulty swallowing, which are more typical of streptococcal pharyngitis, makes this less likely.
- D. Lymphoid lineage neoplasm (34%): Although the patient's lymph nodes have decreased in size over time, which might argue against a neoplastic process, lymphomas can have a variable course, and some types may present with waxing and waning symptoms. The history of hepatitis C, which is a risk factor for certain lymphomas, also keeps this in the differential.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Lymphoid lineage neoplasm (34%): As mentioned, while the clinical course might not strongly suggest a lymphoma, missing this diagnosis could have severe consequences. Lymphomas require specific diagnostic workup and treatment.
- A. Atypical mycobacterial infection (5%): Although less common, atypical mycobacterial infections can cause lymphadenopathy, especially in immunocompromised individuals. The patient's history of hepatitis C and smoking could potentially compromise his immune system, making this a "do not miss" diagnosis due to its treatability and potential severity if left untreated.
- Rare diagnoses
- C. Hepatitis C-related vasculitis (3%): This is a less common complication of hepatitis C infection. While the patient has a history of hepatitis C, the clinical presentation does not strongly suggest vasculitis, which typically involves more systemic symptoms and specific findings on physical examination and laboratory tests.
- Other rare infections or autoimmune conditions: These could also be considered but are less likely given the information provided and would typically require more specific symptoms or laboratory findings to be high on the differential diagnosis list.