Lymphadenopathy differential diagnosis: Difference between revisions

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__NOTOC__
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{{Lymphadenopathy}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Lymphadenopathy]]
{{CMG}}; {{AE}} {{ADS}} [[Ogechukwu Hannah Nnabude, MD]]
 
==Overview==
[[Lymphadenopathy]] can be caused by different disease categories include: [[neoplasms]], such as [[lymphoma]]; [[bacterial]], [[viral]], and [[parasite]] diseases; and inflammatory conditions, such as [[Systemic lupus erythematosus causes|systemic lupus erythematosus]].
 
==Differentiating different causes of Lymphadenopathy ==
Lymphadenopathy can be caused by different disease categories include: neoplasms such as lymphoma; bacterial, viral, and parasites diseases; and inflammatory conditions, such as [[Systemic lupus erythematosus causes|systemic lupus erythematosus]].
 
===Different causes of Lymphadenopathy can be differentiated from each other based on their different clinical manifestation such as pain, constitutional symptoms; and para clinical symptoms such as blood test and pathology on biopsy. ===
 
{|
|-
! colspan="2" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! colspan="7" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pathogonomic finding
|-
| colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|-
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Biopsy
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Painless or painful Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Generalized or localized Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight loss
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Night Sweats
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rash
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunochemistry
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood work
|-
! colspan="13" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |NEOPLASMS
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center" |'''[[Non-Hodgkin lymphoma|Non-Hodgkins lymphoma]]'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Presents with [["B" symptoms]]
* Constant [[Fatigue (physical)|fatigue]]
* [[Shortness of breath]] and [[Cough, hemoptysis, and weight loss|cough]]
* [[Abdominal pain]] or swelling
* [[Constipation]]
* [[Nausea]] and[[vomiting]].
| style="background: #F5F5F5; padding: 5px;" |
* [[Coombs test]] may be positive
* [[Hypogammaglobulinemia]]
* [[Human Immunodeficiency Virus (HIV)|HIV serology]]
* [[Elevated lactate dehydrogenase]]
* [[Abnormal liver function test]]
* [[Hypercalcemia (Assessment and Plan)|Hypercalcemia]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Anemia]]
* [[TAR syndrome|Thrombocytopenia]]
* [[Leukopenia]]
* [[Lymphocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* Monomorphic medium to large sized [[lymphocytes]] seen
| style="background: #F5F5F5; padding: 5px;" |
* N/A
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hodgkin's lymphoma|Hodgkin's disease]]<ref>{{cite book|title=Scientific Style and Format: The CBE Manual for Authors, Editors, and Publishers|url=https://books.google.com/books?id=PoFJ-OhE63UC&pg=PA97|year=1994|publisher=Cambridge University Press|isbn=978-0-521-47154-1|pages=97–}}</ref><ref name="Lozano_2012">{{cite journal  |vauthors=Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, etal | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = Dec 15, 2012 | oclc = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 }}</ref><ref name="pmid15164877">{{cite journal| author=Shishodia S, Aggarwal BB| title=Nuclear factor-kappaB activation mediates cellular transformation, proliferation, invasion angiogenesis and metastasis of cancer. | journal=Cancer Treat Res | year= 2004 | volume= 119 | issue=  | pages= 139-73 | pmid=15164877 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15164877  }}</ref><ref name="pmid8639794">{{cite journal| author=Bargou RC, Leng C, Krappmann D, Emmerich F, Mapara MY, Bommert K et al.| title=High-level nuclear NF-kappa B and Oct-2 is a common feature of cultured Hodgkin/Reed-Sternberg cells. | journal=Blood | year= 1996 | volume= 87 | issue= 10 | pages= 4340-7 | pmid=8639794 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8639794  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Presents with [["B" symptoms]]
 
* Constant [[Fatigue (physical)|fatigue]]
* [[Shortness of breath]] and Cough
* [[Abdominal pain]] or swelling
* [[Constipation]]
* [[Nausea]] and[[vomiting]].
| style="background: #F5F5F5; padding: 5px;" |<nowiki/>
* [[Lactate dehydrogenase|Lactate dehydrogenase (LDH)]] may be increased.
* [[ESR|ESR elevated]]
* Serum [[Creatinine|creatinine elevated]] in nephrotic syndrome.
* [[Alkaline phosphatase|Alkaline phosphatase (ALP) increased]]
* [[Hypercalcemia]], [[hypernatremia]], and [[hypoglycemia]].
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
Fine-needle aspiration
*Mononucleate and binucleate [[Reed-Sternberg cell|Reed-Sternberg cells]] in a background of inflammatory cells
| style="background: #F5F5F5; padding: 5px;" |
* [[Reed-Sternberg cells]] on microscopic pathology.
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Chronic lymphocytic leukemia |Chronic lymphocytic leukemia]]<ref name="pmid25461996">{{cite journal| author=Nabhan C, Rosen ST| title=Chronic lymphocytic leukemia: a clinical review. | journal=JAMA | year= 2014 | volume= 312 | issue= 21 | pages= 2265-76 | pmid=25461996 | doi=10.1001/jama.2014.14553 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25461996  }}</ref><ref name="pmid25908509">{{cite journal| author=Hallek M| title=Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment. | journal=Am J Hematol | year= 2015 | volume= 90 | issue= 5 | pages= 446-60 | pmid=25908509 | doi=10.1002/ajh.23979 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25908509  }}</ref><ref name="patho">Chronic Lymphocytic Leukemia. Libre Pathology (2015) http://librepathology.org/wiki/index.php/B_cell_small_lymphocytic_lymphoma/chronic_lymphocytic_leukemia Accessed on October, 12 2015</ref><ref name="pmid259085092">{{cite journal| author=Hallek M| title=Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment. | journal=Am J Hematol | year= 2015 | volume= 90 | issue= 5 | pages= 446-60 | pmid=25908509 | doi=10.1002/ajh.23979 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25908509  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Recurrent [[bleeding]]
*[[Muscle wasting]]
*Generalized [[weakness]]
*[[Anorexia]]
*[[Abdominal pain]]
*Recurrent [[Infection|infections]]
| style="background: #F5F5F5; padding: 5px;" |
*Monoclonality of kappa and lambda producing [[B cell|B cells]]
*Presence of [[smudge cells]]
 
*Express [[CD19]], [[CD20]], [[CD23]], and [[CD5]] on the [[cell]] surface
| style="background: #F5F5F5; padding: 5px;" |
CBC
*Absolute [[lymphocytosis]] (>5000 cells/μl)
*Decreased [[hemoglobin]] concentration
*Decreased [[Platelet|platelets]] count
| style="background: #F5F5F5; padding: 5px;" |On [[microscopic]] [[histopathological]] analysis:
*Small [[lymphoid]] [[cell]]s
*Thin [[cytoplasmic]] border
*Dense [[nucleus]]  Lack of [[nucleolus]]
*Clumped [[chromatin]] aggregates
*The presence of [[smudge cells]]
*The presence of gumprecht [[nuclear]] shadows
| style="background: #F5F5F5; padding: 5px;" |
* N/A
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Small cell carcinoma of the lung]]<ref name="Zakowski2003">{{cite journal|last1=Zakowski|first1=Maureen F.|title=Pathology of small cell carcinoma of the lung|journal=Seminars in Oncology|volume=30|issue=1|year=2003|pages=3–8|issn=00937754|doi=10.1053/sonc.2003.50015}}</ref><ref name="NCI">National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute.  Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.</ref><ref>{{Cite journal
| author = [[Grace K. Dy]] & [[Alex A. Adjei]]
| title = Novel targets for lung cancer therapy: part I
| journal = [[Journal of clinical oncology : official journal of the American Society of Clinical Oncology]]
| volume = 20
| issue = 12
| pages = 2881–2894
| year = 2002
| month = June
| pmid = 12065566
}}</ref><ref>{{Cite journal
| author = [[K. Hibi]], [[T. Takahashi]], [[Y. Sekido]], [[R. Ueda]], [[T. Hida]], [[Y. Ariyoshi]], [[H. Takagi]] & [[T. Takahashi]]
| title = Coexpression of the stem cell factor and the c-kit genes in small-cell lung cancer
| journal = [[Oncogene]]
| volume = 6
| issue = 12
| pages = 2291–2296
| year = 1991
| month = December
| pmid = 1722571
}}</ref><ref>{{Cite journal
| author = [[Yuri Pekarsky]], [[Alexey Palamarchuk]], [[Kay Huebner]] & [[Carlo M. Croce]]
| title = FHIT as tumor suppressor: mechanisms and therapeutic opportunities
| journal = [[Cancer biology & therapy]]
| volume = 1
| issue = 3
| pages = 232–236
| year = 2002
| month = May-June
| pmid = 12432269
}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Syndrome of inappropriate antidiuresis]] ([[SIADH]])
* [[Hypercalcemia]]
*[[Cough]] (most common symptom)
*[[Wheezing]]
*[[Dyspnea]]
*[[Hemoptysis]]
*[[Chest pain]]
| style="background: #F5F5F5; padding: 5px;" |
Nearly all SCLC are immunoreactive for
*[[keratin]]
*[[thyroid transcription factor 1]]
*[[Epithelial cells|epithelial]] membrane [[antigen]]
[[Neuroendocrine]] and [[neural]] [[differentiation]] result in the expression of molecules like
*[[Dopamine beta-hydroxylase|dopa-decarboxylase]]
*[[calcitonin]]
*[[neuron-specific enolase]],
*[[chromogranin A]]
*[[CD56]]
*[[gastrin]]-releasing [[peptide]]
*[[insulin-like growth factor 1]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* The [[tumor cells]] are small and round, but they can sometimes be ovoid or spindle shaped. 
* They have a scanty[[cytoplasm]] with a [[high mitotic count]] and a [[hyperchromatic]] [[nuclei]].
| style="background: #F5F5F5; padding: 5px;" |
* N/A
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Melanoma]]<ref name="pmid16822996">{{cite journal| author=Miller AJ, Mihm MC| title=Melanoma. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 1 | pages= 51-65 | pmid=16822996 | doi=10.1056/NEJMra052166 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16822996  }}</ref><ref name="book1">{{cite book|last=Schanderdorf D, Kochs C, Livingstone E |date=2013 |title=Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment |publisher=Springer }}</ref><ref name="book2">{{cite book|last=Mooi W, Krausz T|date=2007 |title=Pathology of Melanocytic Disorders 2nd Ed. |publisher=CRC Press}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Rapid growth of an existing [[nevus]]
*[[Nevus|Bleeding nevus]]
*[[Nodule|Cutaneous nodules]]
*[[Hyperpigmentation|Hyper]]/[[Hypopigmented area|hypopigmented skin lesion]]
*[[Melanonychia]] (brown/blue nail discoloration)
*[[Skin ulcer|Non-healing skin ulcer]]
*[[Skin lesion|Painful skin lesion]]
*[[Pruritus]]
*[[Bone pain]]
| style="background: #F5F5F5; padding: 5px;" |
* Positive for [[CD133|CD133+]]
* Positive for [[CD34]]+
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* An [[excisional biopsy]] (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins.
| style="background: #F5F5F5; padding: 5px;" |
* Epidermal atrophy and flattening and prominent dermal invasion
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lymphomatoid granulomatosis]]<ref name="pmid21297689">{{cite journal |vauthors=Denburg JA, Bienenstock J |title=Physiology of the immune response |journal=Can Fam Physician |volume=25 |issue= |pages=301–7 |date=March 1979 |pmid=21297689 |pmc=2382958 |doi= |url=}}</ref><ref name="pmid9547995">{{cite journal| author=Jaffe ES, Wilson WH| title=Lymphomatoid granulomatosis: pathogenesis, pathology and clinical implications. | journal=Cancer Surv | year= 1997 | volume= 30 | issue=  | pages= 233-48 | pmid=9547995 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9547995  }}</ref><ref name="pmidhttps://doi.org/10.1016/S0046-8177(72)80005-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/S0046-8177(72)80005-4 | doi= | pmc=5922622 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref><ref name="pmid11688570">{{cite journal| author=Beaty MW, Toro J, Sorbara L, Stern JB, Pittaluga S, Raffeld M et al.| title=Cutaneous lymphomatoid granulomatosis: correlation of clinical and biologic features. | journal=Am J Surg Pathol | year= 2001 | volume= 25 | issue= 9 | pages= 1111-20 | pmid=11688570 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11688570  }}</ref><ref name="pmid22361129">{{cite journal| author=Bartosik W, Raza A, Kalimuthu S, Fabre A| title=Pulmonary lymphomatoid granulomatosis mimicking lung cancer. | journal=Interact Cardiovasc Thorac Surg | year= 2012 | volume= 14 | issue= 5 | pages= 662-4 | pmid=22361129 | doi=10.1093/icvts/ivr083 | pmc=3329320 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22361129  }}</ref><ref name="pmid22214969">{{cite journal| author=Colby TV| title=Current histological diagnosis of lymphomatoid granulomatosis. | journal=Mod Pathol | year= 2012 | volume= 25 Suppl 1 | issue=  | pages= S39-42 | pmid=22214969 | doi=10.1038/modpathol.2011.149 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22214969  }}</ref><ref name="pmid22745203">{{cite journal| author=Hare SS, Souza CA, Bain G, Seely JM, Gomes MM et al.| title=The radiological spectrum of pulmonary lymphoproliferative disease. | journal=Br J Radiol | year= 2012 | volume= 85 | issue= 1015 | pages= 848-64 | pmid=22745203 | doi=10.1259/bjr/16420165 | pmc=3474050 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22745203  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized or localized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Cough]]
*[[Dyspnea]]
*[[Chest pain|Chest tightness]]
*[[Malaise]]
*[[Fatigue]]
*[[Headache|Headaches]]
*[[Seizure|Seizures]]
*[[Hemiparesis]]
*[[Ataxia]]
*[[Macule|Macules]]
*[[Papule|Papules]]
*[[Plaque|Plaques]]
*[[Nodule (medicine)|Subcutaneous nodules]]
*[[Nodule (medicine)|Larger ulcerated nodules]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
CBC
*[[Leukopenia]]
*[[Lymphocytopenia|Lymphopenia]]
*Low [[CD4]] count
*[[Leukocytosis]] is rare
*Elevated [[Hematocrit]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* On chest CT scan, [[Halo sign]] is seen due to the angioinvasive nature of the disease
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Angioimmunoblastic T-cell lymphoma|Angioimmunoblastic lymphadenopathy]]<ref name="who1">{{cite book |last=Swerdlow |first=S.H. |last2=Campo |first2=E. |last3=Harris |first3=N.L. |last4=Jaffe |first4=E.S. |last5=Pileri |first5=S.A. |last6=Stein |first6=H. |last7=Thiele |first7=J. |last8=Vardiman |first8=J.W |chapter=11 Mature T- and NK-cell neoplasms: Angioimmunoblastic T-cell lymphoma |title=WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues |edition=4th |series=IARC WHO Classification of Tumours |volume=2 |publisher=IARC |year=2008 |isbn=9283224310 |url=http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=70&codcch=4002&content=1}}</ref><ref name="quin1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10524524&query_hl=30&itool=pubmed_ExternalLink] Quintanilla-Martinez L, Fend F, Moguel LR, Spilove L, Beaty MW, Kingma DW, Raffeld M, Jaffe ES. "Peripheral T-cell lymphoma with Reed-Sternberg-like cells of B-cell phenotype and genotype associated with Epstein-Barr virus infection." '''Am J Surg Pathol'''. 1999 Oct;23(10):1233-40. PMID: 10524524</ref><ref name="ree1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=9630171&query_hl=32&itool=pubmed_ExternalLink] Ree HJ, Kadin ME, Kikuchi M, Ko YH, Go JH, Suzumiya J, Kim DS. "Angioimmunoblastic lymphoma (AILD-type T-cell lymphoma) with hyperplastic germinal centers." '''Am J Surg Pathol'''. 1998 Jun;22(6):643-55. PMID: 9630171</ref><ref name="kane12">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3261178&query_hl=40&itool=pubmed_ExternalLink] Kaneko Y, Maseki N, Sakurai M, Takayama S, Nanba K, Kikuchi M, Frizzera G. "Characteristic karyotypic pattern in T-cell lymphoproliferative disorders with reactive "angioimmunoblastic lymphadenopathy with dysproteinemia-type" features." '''Blood'''. 1988 Aug;72(2):413-21. PMID: 3261178</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Edema]]
*[[Chest pain]]
*[[Abdominal pain]]
*[[Bone pain]]
*[[Fatigue]]
*[[Pale skin color]]
*[[Dark urine]]
*[[Chronic pain]] and swelling of the joints
| style="background: #F5F5F5; padding: 5px;" |
*Immunophenotyping
:*Positivity for [[CD2]], [[CD3]], [[CD4]], [[CD5]], [[CD10]], [[CD20]], and focal positivity for [[CXCL13]]
:*Negative for ALK1 and [[CD30]]
*Fluorescence in situ hybridization ([[FISH]])
| style="background: #F5F5F5; padding: 5px;" |
*[[Complete blood count]] (CBC)
:*[[Anemia]]
:*[[Eosinophilia]]
| style="background: #F5F5F5; padding: 5px;" |Lymph node or extranodal tissue biopsy is diagnostic of angioimmunoblastic T-cell lymphoma.
*Characteristic findings on gross pathology, aborization and proliferation of [[high endothelial venules]]
*On microscopic histopathological analysis, [[CD4]]+ [[T-cells]], [[CD8]]+ [[T-cells]], and polyclonal [[plasma cells]].
| style="background: #F5F5F5; padding: 5px;" |
*[[Epstein–Barr virus]] (EBV) has been found in both reactive B-cells  and the neoplastic T-cells.
*[[Trisomy]] 3, trisomy 5, and +X are the most frequent chromosomal abnormalities found in cases.
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Castleman's disease|Giant lymph node hyperplasia]] ([[Castleman's disease|Castleman disease]])<ref>Aoki Y, Yarchoan R, Wyvill K, Okamoto S, Little RF, Tosato G. Detection of viral interleukin-6 in Kaposi sarcoma-associated herpesvirus-linked disorders. Blood 2001;97(7):2173-6.</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Anemia]]
*[[Loss of appetite]]
*[[Cough]]
*Chest discomfort
*[[Fatigue]]
*[[Weakness]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
*[[Complete blood count]] and differential count - [[low white blood cell counts]], which may to be due to the overproduction of [[interleukin 6]].
*[[Erythrocyte sedimentation rate]] - elevated in 80% cases.
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* Hypersecretion of the cytokine [[Interleukin 6|IL-6]].
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" |Diseases
!Lymphadenopathy
!
! colspan="1" rowspan="1" |Fever
!Weight loss
!Night sweats
! colspan="1" rowspan="1" |Rash
!Other symptoms
!Immunochemistry
!Blood work
!Biopsy
Histopathology
!Pathogonomical
findings
|-
! colspan="13" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |INFECTIONS
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Bacteria'''
| style="background:#DCDCDC;" align="center" + |'''[[Syphilis]]<ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }}</ref><ref name="pmid1386838">{{cite journal| author=Fitzgerald TJ| title=The Th1/Th2-like switch in syphilitic infection: is it detrimental? | journal=Infect Immun | year= 1992 | volume= 60 | issue= 9 | pages= 3475-9 | pmid=1386838 | doi= | pmc=257347 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1386838  }}</ref><ref name="pmid10194456">{{cite journal| author=Singh AE, Romanowski B| title=Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 2 | pages= 187-209 | pmid=10194456 | doi= | pmc=88914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10194456  }}</ref><ref name="pmid1911961">{{cite journal| author=Engelkens HJ, ten Kate FJ, Vuzevski VD, van der Sluis JJ, Stolz E| title=Primary and secondary syphilis: a histopathological study. | journal=Int J STD AIDS | year= 1991 | volume= 2 | issue= 4 | pages= 280-4 | pmid=1911961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1911961  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |<nowiki>-</nowiki>
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="left" + |Primary syphilis:
* Chancer
Secondary syphilis:
* Rash
* Condylomata lata
* Patchy [[alopecia]]
Tertiary syphilis
* Gumma
* Organ system involvement
| style="background:#F5F5F5;" align="left" + |
* Darkfield microscopy to detect ''[[T. pallidum]].''
* Nontreponemal tests (e.g., [[VDRL]]<nowiki/>and [[RPR]] )
* Treponemal tests (e.g. [[FTA-ABS]], the TP-PA assay
| style="background:#F5F5F5;" align="center" + |
* N/A
| style="background:#F5F5F5;" align="left" + |
On microscopic [[histopathological]] analysis, characteristic findings of syphilis:
*Mononuclear leukocytic infiltration, [[macrophages]], and [[lymphocytes]].
*Swelling and proliferation of small blood vessels.
| style="background:#F5F5F5;" align="left" + |
* Painless clean base chancre.
|-
| style="background:#DCDCDC;" align="center" + |'''[[Brucellosis]]<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }}</ref><ref name="pmid8698508">{{cite journal| author=Zhan Y, Liu Z, Cheers C| title=Tumor necrosis factor alpha and interleukin-12 contribute to resistance to the intracellular bacterium Brucella abortus by different mechanisms. | journal=Infect Immun | year= 1996 | volume= 64 | issue= 7 | pages= 2782-6 | pmid=8698508 | doi= | pmc=174139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8698508  }}</ref><ref name="pmid2915152">{{cite journal| author=Gazapo E, Gonzalez Lahoz J, Subiza JL, Baquero M, Gil J, de la Concha EG| title=Changes in IgM and IgG antibody concentrations in brucellosis over time: importance for diagnosis and follow-up. | journal=J Infect Dis | year= 1989 | volume= 159 | issue= 2 | pages= 219-25 | pmid=2915152 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2915152  }}</ref><ref name="pmid10858243">{{cite journal| author=Arenas GN, Staskevich AS, Aballay A, Mayorga LS| title=Intracellular trafficking of Brucella abortus in J774 macrophages. | journal=Infect Immun | year= 2000 | volume= 68 | issue= 7 | pages= 4255-63 | pmid=10858243 | doi= | pmc=101738 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10858243  }}</ref><ref name="pmid15694858">{{cite journal| author=Lapaque N, Moriyon I, Moreno E, Gorvel JP| title=Brucella lipopolysaccharide acts as a virulence factor. | journal=Curr Opin Microbiol | year= 2005 | volume= 8 | issue= 1 | pages= 60-6 | pmid=15694858 | doi=10.1016/j.mib.2004.12.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15694858  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painful
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Abdominal pain]]
* [[Hepatosplenomegaly]]
* [[Arthritis]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Brucella|''Brucella'']] is most commonly isolated from blood cultures
 
* Positive titer of anti-[[Brucella|b''rucella'']] [[antibodies]] on serological testing
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Night sweats]], often with characteristic smell, likened to wet hay
|-
| rowspan="4" style="background:#DCDCDC;" align="center" + |'''Viral'''
| style="background:#DCDCDC;" align="center" + |'''[[Infectious mononucleosis]]<ref>{{cite journal |author=Chapman AL, Watkin R, Ellis CJ |title=Abdominal pain in acute infectious mononucleosis |journal=BMJ |volume=324 |issue=7338 |pages=660–1 |year=2002 |pmid=11895827 |doi=10.1136/bmj.324.7338.660}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painful
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="center" + |<nowiki>-</nowiki>
| style="background:#F5F5F5;" align="center" + |<nowiki>-</nowiki>
| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="left" + |
* <nowiki/>Low-grade [[fever]]<nowiki/> without [[chills]]
* [[Sore throat]]
* <nowiki/>White patches on [[tonsils]] and back of the throat
* [[Muscle weakness]]
* [[Fatigue]]
* [[Petechial hemorrhage]]
| style="background:#F5F5F5;" align="left" + |
* A positive reaction to a mono spot test
* Direct detection of [[EBV]] in blood or lymphoid tissues
| style="background:#F5F5F5;" align="left" + |
* A normal to moderately elevated [[White blood cell|white blood cell count]]
* An increased total number of [[lymphocytes]]
* Greater than 10% [[Lymphocytes|atypical lymphocytes]]
* Presence of [[Reactive lymphocyte|atypical lymphocytes]] (a type of mononuclear cell) on the peripheral blood smear.
| style="background:#F5F5F5;" align="left" + |
* N/A
| style="background:#F5F5F5;" align="left" + |
* Presence of [[Reactive lymphocyte|atypical lymphocytes]] (a type of mononuclear cell) on the peripheral blood smear.
|-
| style="background:#DCDCDC;" align="center" + |'''[[CMV]]<ref name="pmid25304390">{{cite journal| author=Griffiths P, Lumley S| title=Cytomegalovirus. | journal=Curr Opin Infect Dis | year= 2014 | volume= 27 | issue= 6 | pages= 554-9 | pmid=25304390 | doi=10.1097/QCO.0000000000000107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25304390  }}</ref><ref name="pmid27526428">{{cite journal| author=Pytka D, Czarkowska-Pączek B| title=[CMV infection in elderly]. | journal=Przegl Lek | year= 2016 | volume= 73 | issue= 4 | pages= 241-4 | pmid=27526428 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27526428  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painful
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background:#F5F5F5;" align="left" + |<nowiki>+</nowiki>
| style="background:#F5F5F5;" align="left" + |<nowiki>-</nowiki>
| style="background:#F5F5F5;" align="left" + |<nowiki>-</nowiki>
| style="background:#F5F5F5;" align="left" + |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
* [[Floaters]]
* [[Scotoma|Scotomata]]
* Peripheral [[Visual field defect|visual field defects]]
* [[Odynophagia]]
* [[Nausea]]
* [[Lethargy]]
* [[Confusion]]
* [[Altered mental status]]
| style="background: #F5F5F5; padding: 5px;" |
* Positive [[PCR]] for [[CMV]].
| style="background: #F5F5F5; padding: 5px;" |
* [[Hemolytic anemia]]
* [[Thrombocytopenia]]
* [[Disseminated intravascular coagulation]]
* [[Pancytopenia]]
| style="background: #F5F5F5; padding: 5px;" |
* [[CMV infection]] demonstrates the presence of intranuclear [[inclusion]] bodies. These [[inclusion bodies]] stain dark pink on an [[H&E stain]], and are also called "Owl's Eye" [[inclusion bodies]].
| style="background: #F5F5F5; padding: 5px;" |
* Owl Eye inclusion bodies.
|-
| style="background:#DCDCDC;" align="center" + |'''[[HIV]]<ref name="pmid8093551">{{cite journal| author=Pantaleo G, Graziosi C, Fauci AS| title=New concepts in the immunopathogenesis of human immunodeficiency virus infection. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 5 | pages= 327-35 | pmid=8093551 | doi=10.1056/NEJM199302043280508 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8093551  }}</ref><ref name="Coovadia">{{cite journal
| author=Coovadia, H.
| title=Antiretroviral agents&mdash;how best to protect infants from HIV and save their mothers from AIDS | journal=N. Engl. J. Med.
| year=2004
| pages=289-292
| volume=351
| issue=3
| pmid=15247337
| format=
}}</ref><ref name="pmid2963151">{{cite journal
|author=Lifson AR
|title=Do alternate modes for transmission of human immunodeficiency virus exist? A review
|journal=JAMA
|volume=259
|issue=9
|pages=1353–6
|year=1988
|pmid=2963151
|doi=
}}</ref><ref name="WHOUNAIDScircum">{{cite web
| author=WHO | publisher=WHO.int | year=2007
| url=http://www.who.int/hiv/mediacentre/news68/en/index.html
| title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention
| accessdate=2007-07-13
 
}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painful or painless
| style="background: #F5F5F5; padding: 5px;" |Generalized or localized
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
* [[Fatigue]]
* [[Myalgia]]
* Arthritic pain
* [[Headache]]
* [[Memory loss]], [[depression]] and other neurological disorders
| style="background: #F5F5F5; padding: 5px;" |
* ELISA
* Dot blot
* Latex agglutination assays
* [[Western blot|Western blot assays]]
* [[P24 antigen]] assays
* [[CD4|CD4 T-cell]] count ([[CD4 count]])
* Plasma HIV RNA viral load
| style="background: #F5F5F5; padding: 5px;" |
* Anaemia
* Thrombocytopenia
* Leukopenia
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background:#F5F5F5;" align="left" + |
* Plasma HIV RNA viral load
|-
| style="background:#DCDCDC;" align="center" + | '''[[Cat scratch disease]]<ref>{{cite journal |author=Chomel BB |title=Experimental transmission of Bartonella henselae by the cat flea |journal=J. Clin. Microbiol. |volume=34 |issue=8 |pages=1952–6 |year=1996 |month=August |pmid=8818889 |pmc=229161 |author-separator=, |author2=Kasten RW |author3=Floyd-Hawkins K |display-authors=3 |last4=Chi |first4=B |last5=Yamamoto |first5=K |last6=Roberts-Wilson |first6=J |last7=Gurfield |first7=AN |last8=Abbott |first8=RC |last9=Pedersen |first9=NC}}</ref><ref>{{cite journal |author=Higgins JA, Radulovic S, Jaworski DC, Azad AF |title=Acquisition of the cat scratch disease agent Bartonella henselae by cat fleas (Siphonaptera:Pulicidae) |journal=J. Med. Entomol. |volume=33 |issue=3 |pages=490–5 |year=1996 |month=May |pmid=8667399}}</ref><ref>{{cite journal |author=Telford SR III, Wormser GP |title=Bartonella spp. transmission by ticks not established |journal=Emerg Infect Dis |volume=16 |issue=3 |pages=379–84 |year=2010 |month=March |pmid= 20202410 |doi=10.3201/eid1603.090443}}</ref><ref>{{cite journal |author=Foil L |title=Experimental infection of domestic cats with Bartonella henselae by inoculation of Ctenocephalides felis (Siphonaptera: Pulicidae) feces |journal=J. Med. Entomol. |volume=35 |issue=5 |pages=625–8 |year=1998 |month=September |pmid=9775583 |author-separator=, |author2=Andress E |author3=Freeland RL |display-authors=3 |last4=Roy |first4=AF |last5=Rutledge |first5=R |last6=Triche |first6=PC |last7=O'Reilly |first7=KL}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painful
| style="background: #F5F5F5; padding: 5px;" |Localized
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
* [[Back pain]]
* [[Headache]]
* [[Sore throat]]
* [[Abdominal pain]]
* Vision problems
* [[Malaise]]
* [[Altered mental status|Alteration of mental status]]
* [[Convulsion|Convulsions]]
| style="background: #F5F5F5; padding: 5px;" |
* Indirect [[immunofluorescence]] or enzymatic i[[mmunoassay]] with titration of [[IgG]] or [[IgM]] antibodies to detect serum antibody to B henselae.
* [[Polymerase chain reaction]] ([[PCR]]) is the most sensitive test
| style="background: #F5F5F5; padding: 5px;" |
* [[Lymphocytosis]] is seen in the acute phase.
* [[Erythrocyte sedimentation rate]] - elevated.
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* Painful [[Bubo|buboes]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Mycobacteria'''
| style="background:#DCDCDC;" align="center" + |'''[[Tuberculosis]]<ref name="Herrmann_2005">{{cite journal |author=Herrmann J, Lagrange P |title=Dendritic cells and Mycobacterium tuberculosis: which is the Trojan horse? |journal=Pathol Biol (Paris) |volume=53 |issue=1 |pages=35–40 |year=2005 | pmid = 15620608}}</ref><ref name="pmid22811737">{{cite journal| author=Silva Miranda M, Breiman A, Allain S, Deknuydt F, Altare F| title=The tuberculous granuloma: an unsuccessful host defence mechanism providing a safety shelter for the bacteria? | journal=Clin Dev Immunol | year= 2012 | volume= 2012 | issue=  | pages= 139127 | pmid=22811737 | doi=10.1155/2012/139127 | pmc=PMC3395138 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22811737  }}</ref><ref name="pmid228117372">{{cite journal| author=Silva Miranda M, Breiman A, Allain S, Deknuydt F, Altare F| title=The tuberculous granuloma: an unsuccessful host defence mechanism providing a safety shelter for the bacteria? | journal=Clin Dev Immunol | year= 2012 | volume= 2012 | issue=  | pages= 139127 | pmid=22811737 | doi=10.1155/2012/139127 | pmc=PMC3395138 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22811737  }}</ref><ref name="pmid21420161">{{cite journal| author=Lawn SD, Zumla AI| title=Tuberculosis. | journal=Lancet | year= 2011 | volume= 378 | issue= 9785 | pages= 57-72 | pmid=21420161 | doi=10.1016/S0140-6736(10)62173-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21420161  }}</ref><ref name="pmid23425167">{{cite journal| author=Zumla A, Raviglione M, Hafner R, von Reyn CF| title=Tuberculosis. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 8 | pages= 745-55 | pmid=23425167 | doi=10.1056/NEJMra1200894 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23425167  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painful
| style="background: #F5F5F5; padding: 5px;" |Generalized or localized
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
* [[Hemoptysis]]
* [[Chest pain]]
* [[Anorexia]]
* [[Malaise]]
* [[Chills]]
* [[Fatigue]]
* [[Dyspnea]]
| style="background: #F5F5F5; padding: 5px;" |
* [[PCR]] of [[CSF]] for [[tuberculosis]]
* Mycobacterial culture of CSF
* Brain biopsy for [[acid-fast bacilli]] staining
* Culture and acid stain positive for [[acid-fast bacilli]]
* [[Hyponatremia]]
* [[Hypercalcemia]]
* Elevated [[alkaline phosphatase]] levels
* Mild elevation of [[liver enzymes]]
*
| style="background: #F5F5F5; padding: 5px;" |
* Mild normocytic [[anemia]] may be present in almost half of patients.
* Increased [[erythrocyte sedimentation rate]] (ESR)
* Mild [[leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* M[[Macrophages|acrophages]],  other [[immune cells]] such as blood [[monocytes]] (tissue [[macrophages]]) and [[lymphocytes]] also migrate to the [[Ghon focus]] aiding in the termination of the infection or initiation of a [[Granuloma|granulomatous]] containment.
| style="background: #F5F5F5; padding: 5px;" |
* [[Gohn's focus]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Parasite'''
| style="background:#DCDCDC;" align="center" + |'''[[Toxoplasmosis]]<ref name="pmid19870956">{{cite journal| author=Wolf A, Cowen D, Paige BH| title=TOXOPLASMIC ENCEPHALOMYELITIS : IV. EXPERIMENTAL TRANSMISSION OF THE INFECTION TO ANIMALS FROM A HUMAN INFANT. | journal=J Exp Med | year= 1940 | volume= 71 | issue= 2 | pages= 187-214 | pmid=19870956 | doi= | pmc=2135077 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19870956  }}</ref><ref name="pmid18128617">{{cite journal| author=FRENKEL JK| title=Pathogenesis, diagnosis and treatment of human toxoplasmosis. | journal=J Am Med Assoc | year= 1949 | volume= 140 | issue= 4 | pages= 369-77 | pmid=18128617 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18128617  }}</ref><ref name="pmid4592096">{{cite journal| author=Frenkel JK| title=Pathology and pathogenesis of congenital toxoplasmosis. | journal=Bull N Y Acad Med | year= 1974 | volume= 50 | issue= 2 | pages= 182-91 | pmid=4592096 | doi= | pmc=1749352 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4592096  }}</ref><ref name="pmid7026410">{{cite journal| author=Conley FK, Jenkins KA, Remington JS| title=Toxoplasma gondii infection of the central nervous system. Use of the peroxidase-antiperoxidase method to demonstrate toxoplasma in formalin fixed, paraffin embedded tissue sections. | journal=Hum Pathol | year= 1981 | volume= 12 | issue= 8 | pages= 690-8 | pmid=7026410 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7026410  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized or localized
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | <nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background:#F5F5F5;" align="left" + |
* [[Sore throat]]
* [[Muscle aches]] and [[pains]]
| style="background:#F5F5F5;" align="left" + |
* [[IgG]], [[IgM]], [[IgA]] antibodies against toxoplasmosis seen by [[ELISA]]
* [[PCR]]
| style="background:#F5F5F5;" align="left" + |
* N/A
| style="background:#F5F5F5;" align="left" + |
* Microscopy of the lesions demonstrate [[periaqueductal]] and [[periventricular]] [[vasculitis]] with [[necrosis]].
* Fetal tissue and [[placenta]] can demonstrate [[t.gondii]] [[cysts]] with [[the]] [[Wright-Giemsa stain|Wright-Giemsa]] stain and also with [[immunoperoxidase]] staining using [[t.gondii]]–specific [[antibodies]].
| style="background:#F5F5F5;" align="left" + |
* Multiple [[ring enhancing lesion]] on [[CT]] Brain.
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" |Diseases
!Lymphadenopathy
!
! colspan="1" rowspan="1" |Fever
!Weight loss
!Night sweats
! colspan="1" rowspan="1" |Rash
!Other symptoms
!Immunochemistry
!Blood work
!Biopsy
Histopathology
!Pathogonomical
findings
|-
! colspan="13" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |AUTOIMMUNE   
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Systemic lupus erythematosus causes|'''Systemic lupus erythematosus''']]
'''(SLE)<ref name="pmid8519610">{{cite journal |vauthors=Elkon K |title=Autoantibodies in systemic lupus erythematosus |journal=Curr Opin Rheumatol |volume=7 |issue=5 |pages=384–8 |year=1995 |pmid=8519610 |doi= |url=}}</ref><ref name="pmid25449682">{{cite journal |vauthors=Yaniv G, Twig G, Shor DB, Furer A, Sherer Y, Mozes O, Komisar O, Slonimsky E, Klang E, Lotan E, Welt M, Marai I, Shina A, Amital H, Shoenfeld Y |title=A volcanic explosion of autoantibodies in systemic lupus erythematosus: a diversity of 180 different antibodies found in SLE patients |journal=Autoimmun Rev |volume=14 |issue=1 |pages=75–9 |year=2015 |pmid=25449682 |doi=10.1016/j.autrev.2014.10.003 |url=}}</ref><ref name="pmid23672591">{{cite journal |vauthors=Dye JR, Ullal AJ, Pisetsky DS |title=The role of microparticles in the pathogenesis of rheumatoid arthritis and systemic lupus erythematosus |journal=Scand. J. Immunol. |volume=78 |issue=2 |pages=140–8 |year=2013 |pmid=23672591 |doi=10.1111/sji.12068 |url=}}</ref><ref name="pmid15593221">{{cite journal |vauthors=Kirou KA, Lee C, George S, Louca K, Papagiannis IG, Peterson MG, Ly N, Woodward RN, Fry KE, Lau AY, Prentice JG, Wohlgemuth JG, Crow MK |title=Coordinate overexpression of interferon-alpha-induced genes in systemic lupus erythematosus |journal=Arthritis Rheum. |volume=50 |issue=12 |pages=3958–67 |year=2004 |pmid=15593221 |doi=10.1002/art.20798 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized or localized
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Fatigue]]
* [[Myalgia]]
* Joint [[tenderness]]
* [[Muscle weakness]]
* [[Abdominal pain]]
* [[Bloating]]
* [[Distension]]
| style="background: #F5F5F5; padding: 5px;" |
*<nowiki/>[[ANA]] positive
* [[Lupus anticoagulant]] (LA)
* [[IgG]] and [[IgM]] [[Anti-cardiolipin antibodies|anticardiolipin (aCL) antibodies]]
* [[IgG]] and [[IgM]] anti-beta2-[[glycoprotein]] (GP)
* [[C3]]: Vary between varying between normal to slightly reduced
* [[C4.5 algorithm|C4]]: Reduced
* [[CH50]]: Reduced
| style="background: #F5F5F5; padding: 5px;" |
* [[Leukopenia]]
* [[Lymphopenia]]
* Mild [[anemia]]
* [[Thrombocytopenia]]
* [[ESR]]
* [[CRP]]<nowiki/>elevated
| style="background: #F5F5F5; padding: 5px;" |
* [[Lupus erythematosus]] (LE) cells can be seen in SLE.
* LE cells are [[neutrophils]] that have engulfed an intact [[Cell nucleus|nucleus]]. LE cells are also known as LE bodies.
| style="background: #F5F5F5; padding: 5px;" |
* [[Malar rash]] and [[photosensitivity]]
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Sjögren's syndrome case study one|Sjögren's syndrome]]<ref name="pmid24162151">{{cite journal |vauthors=Ramos-Casals M, Brito-Zerón P, Solans R, Camps MT, Casanovas A, Sopeña B, Díaz-López B, Rascón FJ, Qanneta R, Fraile G, Pérez-Alvarez R, Callejas JL, Ripoll M, Pinilla B, Akasbi M, Fonseca E, Canora J, Nadal ME, de la Red G, Fernández-Regal I, Jiménez-Heredia I, Bosch JA, Ayala MD, Morera-Morales L, Maure B, Mera A, Ramentol M, Retamozo S, Kostov B |title=Systemic involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry) |journal=Rheumatology (Oxford) |volume=53 |issue=2 |pages=321–31 |date=February 2014 |pmid=24162151 |doi=10.1093/rheumatology/ket349 |url=}}</ref><ref name="pmid23436818">{{cite journal |vauthors=Yazdany J, Schmajuk G, Robbins M, Daikh D, Beall A, Yelin E, Barton J, Carlson A, Margaretten M, Zell J, Gensler LS, Kelly V, Saag K, King C |title=Choosing wisely: the American College of Rheumatology's Top 5 list of things physicians and patients should question |journal=Arthritis Care Res (Hoboken) |volume=65 |issue=3 |pages=329–39 |date=March 2013 |pmid=23436818 |pmc=4106486 |doi=10.1002/acr.21930 |url=}}</ref><ref name="pmid26766898">{{cite journal |vauthors=Beckman KA, Luchs J, Milner MS |title=Making the diagnosis of Sjögren's syndrome in patients with dry eye |journal=Clin Ophthalmol |volume=10 |issue= |pages=43–53 |date=2016 |pmid=26766898 |pmc=4699514 |doi=10.2147/OPTH.S80043 |url=}}</ref><ref name="pmid28367079">{{cite journal |vauthors=Both T, Dalm VA, van Hagen PM, van Daele PL |title=Reviewing primary Sjögren's syndrome: beyond the dryness - From pathophysiology to diagnosis and treatment |journal=Int J Med Sci |volume=14 |issue=3 |pages=191–200 |date=2017 |pmid=28367079 |pmc=5370281 |doi=10.7150/ijms.17718 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized or localized
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Xerosis]]
* [[Scaly skin]]
* Annular [[erythema]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Anti-Ro/SSA]]
* [[Anti-La/SSB]]
* Presence of [[rheumatoid factor]] (RF)
* Presence of [[anti–alpha-fodrin antibody]] (diagnostic marker of juvenile [[Sjögren's syndrome]])
| style="background: #F5F5F5; padding: 5px;" |
* Elevated [[erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]])
* [[Anemia]]
* [[Leukopenia]]
* [[Thrombocytopenia]]
* [[Eosinophilia]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Keratoconjunctivitis sicca]]
* Presence of anti–alpha-fodrin antibody
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Sarcoidosis]]<ref>Iannuzzi MC, Rybicki BA, Teirstein AS: Sarcoidosis. N Engl J Med 357:2153–2165, 2007.</ref><ref>Zissel G: Cellular activation in the immune response of sarcoidosis. Semin Respir Crit Care Med 35:307–315, 2014.</ref><ref>Rosen Y: Pathology of sarcoidosis. Semin Respir Crit Care Med 28(1):36–52, 2007.</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Painless
| style="background: #F5F5F5; padding: 5px;" |Generalized
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Can involve all [[organ systems]] to varying extent and degree.
| style="background: #F5F5F5; padding: 5px;" |
*Serum [[ACE]] level
 
*Serum chitotriosidase
*Soluble [[IL-2 receptor|interleukin-2 receptor]]
*[[Hypercalcemia]]
*[[Kveim test]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Biopsy of lung
* Non-[[caseating]] [[granuloma]]
| style="background: #F5F5F5; padding: 5px;" |
* Non-[[caseating]][[granuloma]]
|}


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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:primary care]]
[[Category:Inflammations]]
[[Category:Inflammations]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Infectious disease]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Physical examination]]
[[Category:Physical examination]]
[[Category:Needs content]]
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{{WH}}
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Latest revision as of 05:15, 9 December 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[5] Ogechukwu Hannah Nnabude, MD

Overview

Lymphadenopathy can be caused by different disease categories include: neoplasms, such as lymphoma; bacterial, viral, and parasite diseases; and inflammatory conditions, such as systemic lupus erythematosus.

Differentiating different causes of Lymphadenopathy

Lymphadenopathy can be caused by different disease categories include: neoplasms such as lymphoma; bacterial, viral, and parasites diseases; and inflammatory conditions, such as systemic lupus erythematosus.

Different causes of Lymphadenopathy can be differentiated from each other based on their different clinical manifestation such as pain, constitutional symptoms; and para clinical symptoms such as blood test and pathology on biopsy.

Diseases Clinical manifestations Para-clinical findings Pathogonomic finding
Symptoms
Lab Findings Biopsy
Painless or painful Lymphadenopathy Generalized or localized Lymphadenopathy Fever Weight loss Night Sweats Rash Other symptoms Immunochemistry Blood work
NEOPLASMS
Non-Hodgkins lymphoma Painless Generalized + + + +
  • N/A
Hodgkin's disease[1][2][3][4] Painless Generalized + + + +
  • N/A

Fine-needle aspiration

Chronic lymphocytic leukemia[5][6][7][8] Painless Generalized + + + -

CBC

On microscopic histopathological analysis:
  • N/A
Small cell carcinoma of the lung[9][10][11][12][13] Painless Localized - - - -

Nearly all SCLC are immunoreactive for

Neuroendocrine and neural differentiation result in the expression of molecules like

  • N/A
  • N/A
Melanoma[14][15][16] Painless Localized - - - -
  • N/A
  • An excisional biopsy (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins.
  • Epidermal atrophy and flattening and prominent dermal invasion
Lymphomatoid granulomatosis[17][18][19][20][21][22][23] Painless Generalized or localized + + - +
  • N/A

CBC

  • N/A
  • On chest CT scan, Halo sign is seen due to the angioinvasive nature of the disease
Angioimmunoblastic lymphadenopathy[24][25][26][27] Painless Generalized + + + +
  • Immunophenotyping
  • Fluorescence in situ hybridization (FISH)
Lymph node or extranodal tissue biopsy is diagnostic of angioimmunoblastic T-cell lymphoma.
  • Epstein–Barr virus (EBV) has been found in both reactive B-cells and the neoplastic T-cells.
  • Trisomy 3, trisomy 5, and +X are the most frequent chromosomal abnormalities found in cases.
Giant lymph node hyperplasia (Castleman disease)[28] Painless Localized + + - -
  • N/A
  • N/A
  • Hypersecretion of the cytokine IL-6.
Diseases Lymphadenopathy Fever Weight loss Night sweats Rash Other symptoms Immunochemistry Blood work Biopsy

Histopathology

Pathogonomical

findings

INFECTIONS
Bacteria Syphilis[29][30][31][32] Painless Localized + - - + Primary syphilis:
  • Chancer

Secondary syphilis:

Tertiary syphilis

  • Gumma
  • Organ system involvement
  • Darkfield microscopy to detect T. pallidum.
  • Nontreponemal tests (e.g., VDRLand RPR )
  • Treponemal tests (e.g. FTA-ABS, the TP-PA assay
  • N/A

On microscopic histopathological analysis, characteristic findings of syphilis:

  • Mononuclear leukocytic infiltration, macrophages, and lymphocytes.
  • Swelling and proliferation of small blood vessels.
  • Painless clean base chancre.
Brucellosis[33][34][35][36][37] Painful Localized + - - +
  • Brucella is most commonly isolated from blood cultures
  • N/A
  • N/A
  • Night sweats, often with characteristic smell, likened to wet hay
Viral Infectious mononucleosis[38] Painful Localized + - - +
  • A positive reaction to a mono spot test
  • Direct detection of EBV in blood or lymphoid tissues
  • N/A
CMV[39][40] Painful Localized + - - +
  • Owl Eye inclusion bodies.
HIV[41][42][43][44] Painful or painless Generalized or localized - + - -
  • Anaemia
  • Thrombocytopenia
  • Leukopenia
  • N/A
  • Plasma HIV RNA viral load
Cat scratch disease[45][46][47][48] Painful Localized + - - +
  • N/A
Mycobacteria Tuberculosis[49][50][51][52][53] Painful Generalized or localized + + + +
Parasite Toxoplasmosis[54][55][56][57] Painless Generalized or localized + - + -
  • N/A
Diseases Lymphadenopathy Fever Weight loss Night sweats Rash Other symptoms Immunochemistry Blood work Biopsy

Histopathology

Pathogonomical

findings

AUTOIMMUNE
Systemic lupus erythematosus

(SLE)[58][59][60][61]

Painless Generalized or localized + +/- - +
Sjögren's syndrome[62][63][64][65] Painless Generalized or localized - - - +
  • N/A
Sarcoidosis[66][67][68] Painless Generalized - - - -
  • Serum ACE level
  • N/A
Biopsy of lung

References

  1. Scientific Style and Format: The CBE Manual for Authors, Editors, and Publishers. Cambridge University Press. 1994. pp. 97–. ISBN 978-0-521-47154-1.
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  5. Nabhan C, Rosen ST (2014). "Chronic lymphocytic leukemia: a clinical review". JAMA. 312 (21): 2265–76. doi:10.1001/jama.2014.14553. PMID 25461996.
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  14. Miller AJ, Mihm MC (2006). "Melanoma". N Engl J Med. 355 (1): 51–65. doi:10.1056/NEJMra052166. PMID 16822996.
  15. Schanderdorf D, Kochs C, Livingstone E (2013). Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment. Springer.
  16. Mooi W, Krausz T (2007). Pathology of Melanocytic Disorders 2nd Ed. CRC Press.
  17. Denburg JA, Bienenstock J (March 1979). "Physiology of the immune response". Can Fam Physician. 25: 301–7. PMC 2382958. PMID 21297689.
  18. Jaffe ES, Wilson WH (1997). "Lymphomatoid granulomatosis: pathogenesis, pathology and clinical implications". Cancer Surv. 30: 233–48. PMID 9547995.
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  20. Beaty MW, Toro J, Sorbara L, Stern JB, Pittaluga S, Raffeld M; et al. (2001). "Cutaneous lymphomatoid granulomatosis: correlation of clinical and biologic features". Am J Surg Pathol. 25 (9): 1111–20. PMID 11688570.
  21. Bartosik W, Raza A, Kalimuthu S, Fabre A (2012). "Pulmonary lymphomatoid granulomatosis mimicking lung cancer". Interact Cardiovasc Thorac Surg. 14 (5): 662–4. doi:10.1093/icvts/ivr083. PMC 3329320. PMID 22361129.
  22. Colby TV (2012). "Current histological diagnosis of lymphomatoid granulomatosis". Mod Pathol. 25 Suppl 1: S39–42. doi:10.1038/modpathol.2011.149. PMID 22214969.
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