Hodgkin's lymphoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hodgkin's lymphoma must be differentiated from sarcoidosis, lymphocytic lymphoma, miliary tuberculosis, infectious mononucleosis, thoracic aortic aneurysm, substernal goiter, thymoma, actinomycosis, chronic lymphocytic leukemia, superior vena cava syndrome, unicentric castleman disease, adult still disease, small cell lung carcinoma, and malignant histiocytosis.

Differentiating Hodgkin's Lymphoma From Other Diseases

Differentiating diagnosis of Lymphoma Symptoms Signs Diagnosis Additional Findings
Fever Rash Diarrhea Abdominal pain Weight loss Painful lymphadenopathy Hepatosplenomegaly Arthritis Lab Findings
Lymphoma Increase ESR, increased LDH Night sweats, constant fatigue
Brucellosis Relative lymphocytosis Night sweats, often with characteristic smell, likened to wet hay
Typhoid fever Decreased hemoglobin Incremental increase in temperature initially and than sustained fever as high as 40°C (104°F)
Malaria Microcytosis,

elevated LDH

"Tertian" fever: paroxysms occur every second day
Tuberculosis Mild normocytic anemiahyponatremia, and

hypercalcemia

Night sweats, constant fatigue
Mumps Relative lymphocytosis, serum amylaseelevated Parotidswelling/tenderness
Rheumatoid arthritis ESR and CRP elevated, positive rheumatoid factor Morning stiffness
SLE ESR and CRP elevated, positive ANA Fatigue
HIV Constant fatigue

Other Differentials

The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]

Category of Disease Diseases Signs and symptoms Laboratory findings
Fever Fatigue Arthralgia Myalgia Soft tissue swelling/serositis Skin rash Weight loss Dyspnea Sore throat Lymphadenopathy Complete blood count (CBC) Liver function tests (LFTs)

Inflammatory markers

Autoantibodies

Diagnostic tests

Erythrocyte sedimentation rate (ESR) C- reactive protein (CRP) Anti-nuclear antibodies (ANA) Rheumatoid factor (RF) Anti- glomerular basement membrane (anti-GBM) Anti-dsDNA Anti-Jo1/ Anti Mi2 ANCA

Infections

 HIV + + + + +/- - + +/- + /- + - - - - - -
 Herpesviridae + + + + + - - +/- + - - - - - - -
 Measles + + + + - - - + + - - - - - - -
 Viral hepatitis + + - +/- - - +/- - - +/- - - - - - -
 Parvovirus B19 + + + +/- -
  • Slapped cheek rash
- - - + - - - - - -
Infective endocarditis + + + +/- - +/- + - + - - - - - - - Blood cultures, ultrasonography
Borreliosis, Brucellosis, Yersiniosis + + + + - - - - + - - - - - - Serology, PCR
Syphilis and Jarisch-Herxheimer reaction + + + + - - - + +
  • ALT (Uncommon)
  • AST (Uncommon)
- - - - - - Serology, PCR
Toxoplasmosis + + - + - - - + + - - - - - - Serology, PCR

Neoplasia

Malignant lymphoma + + - +/- +/- + + - + - - - - - - CT, PET/CT, Bone marrow examination, lymph node biopsy
Multicentric Castleman disease + + - - + - + + - + - - - - - - - Lymph node biopsy
Angioimmunoblastic T cell lymphoma + + - - - + - - + - - - - - - Lymph node biopsy

Drug hypersensitivity

Drug reaction with eosinophilia and systemic symptoms + + + + +/- - + - - - - - - - - - Eosinophil count, skin biopsy
Autoimmune conditions Systemic lupus erythematosus + + + +/- + + + - +/- + + - + - - Antinuclear autoantibodies
Inflammatory myositis + + - + (weakness > pain) -
  • Macular red rash over the back of the fingers, elbows or knees (Grotton's sign)
  • Macular purpish or reddish rash on the upper chest or back  (Shawl-like, heliotrope rash)
- - - +/- - +/- +/- - - + - Idem, muscle biopsy
Rheumatoid arthritis + + + - + - + - + - +/- +/- - - - - Anti-citrullinated peptids autoantibodies, rheumatoid factor
Systemic vasculitides + + + - + - +/- - +/- - - - +/- - - + ANCA, tissue biopsy, arteriography
Familial Mediterranean fever + + + + + + + (due to pain) - +/- - - - - - - - Familial history, MEFV gene analysis
Mevalonate kinase deficiency + + + + - + - + + - - - - - - - Urinary mevalonic acid, mevalonate kinase analysis
Reactive arthritis + + + - - - + (Aortic insufficiency) - + - - - - - - - HLA B27, magnetic resonance imaging

Miscellaneous

Sarcoidosis + + + - + + + - +
  • Normal ALT, AST
  • ALP ↑ (infiltrative pattern)
- - - - - -
  • Lymph node/Lung biopsy
  • ACE levels
  • FDG-PET

References

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