Differential Diagnosis for a 22-year-old Female with Lymph Node Enlargement
Single Most Likely Diagnosis
- Infectious Mononucleosis (IMN) due to Epstein-Barr Virus (EBV): The patient was tested positive for EBV in December and is still experiencing lymph node enlargement, which is consistent with the prolonged course of IMN. The symptom exacerbation during stress could be related to the body's immune response.
Other Likely Diagnoses
- Reactive Lymphadenopathy: This condition involves lymph node enlargement in response to infection, inflammation, or other stimuli. Given the patient's history of EBV and the exacerbation of symptoms during stress, reactive lymphadenopathy could be a contributing factor.
- Stress-induced Immune Modulation: Stress can modulate the immune system, potentially exacerbating lymph node enlargement in individuals with pre-existing conditions like EBV infection.
- Hormonal Influence on Immune Response: The use of birth control could potentially influence the immune response, although this is less directly related to lymph node enlargement.
Do Not Miss Diagnoses
- Lymphoma: Although less likely, lymphoma (e.g., Hodgkin lymphoma) is a critical diagnosis not to miss, as it can present with lymphadenopathy and may be triggered by EBV infection in rare cases.
- Tuberculosis (TB): TB can cause lymph node enlargement and should be considered, especially if the patient has been exposed to TB or has risk factors for the disease.
- HIV Infection: HIV can cause persistent generalized lymphadenopathy and should be considered in the differential diagnosis, especially if the patient has risk factors for HIV infection.
Rare Diagnoses
- Autoimmune Lymphoproliferative Syndrome (ALPS): A rare genetic disorder that can cause chronic lymphadenopathy and is associated with an increased risk of lymphoma.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, often accompanied by fever and night sweats.
- Castleman Disease: A rare disorder that involves an overgrowth of cells in the body's lymph nodes, which can cause lymphadenopathy.