Differential Diagnosis for a 37-year-old Female with a Tender Neck Gland
Single Most Likely Diagnosis
- Viral lymphadenitis: This is the most likely diagnosis given the presence of a tender and mobile lymph node in the neck, accompanied by chills but no fever, sore throat, or congestion. Viral infections can cause lymphadenopathy without the typical symptoms of a bacterial infection.
Other Likely Diagnoses
- Bacterial lymphadenitis: Although less likely due to the absence of fever, bacterial infections such as streptococcal or staphylococcal infections can cause lymphadenitis. The presence of chills could suggest a systemic response to infection.
- Cat scratch disease: Caused by Bartonella henselae, this infection can lead to lymphadenopathy, typically in the neck, after a cat scratch or bite. The absence of fever does not rule out this diagnosis.
- Toxoplasmosis: A parasitic infection that can cause lymphadenopathy, often without systemic symptoms like fever. It's a consideration, especially if the patient has been exposed to undercooked meat or cat feces.
Do Not Miss Diagnoses
- Lymphoma: Although rare, lymphoma can present with lymphadenopathy that is painless or tender. It's crucial to consider this diagnosis to ensure timely investigation and treatment if necessary.
- Tuberculosis (TB): TB can cause lymphadenitis, often without systemic symptoms initially. Given the potential severity and need for specific treatment, it's a diagnosis not to be missed, especially in individuals with risk factors for TB exposure.
- Metastatic cancer: In rare cases, a metastatic cancer can present with a single, tender lymph node. This diagnosis is critical to rule out, especially in adults, as it significantly affects treatment and prognosis.
Rare Diagnoses
- Sarcoidosis: A systemic disease that can cause lymphadenopathy among other symptoms. It's less likely but should be considered if other diagnoses are ruled out and the patient has other systemic symptoms or findings suggestive of sarcoidosis.
- Kikuchi-Fujimoto disease: A rare, self-limiting condition that causes lymphadenitis, often in young women. It can present with tender lymph nodes and systemic symptoms like fever, although fever is not present in this case.
- Kimura disease: A rare, chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia. It's more common in Asian males but should be considered in the differential diagnosis of lymphadenopathy of unknown origin.