Hodgkin's lymphoma differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Hodgkin's lymphoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hodgkin%27s_lymphoma]]
{{CMG}}
{{CMG}}
==Overview==
==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.
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==
{| class="wikitable"
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating diagnosis of Lymphoma
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Additional Findings
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Rash
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Abdominal pain
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Painful lymphadenopathy
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hepatosplenomegaly
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Arthritis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab Findings
|-
| style="background:#DCDCDC;" align="center" + |[[Lymphoma]]
|✔
|✘
|✘
|✔
|✔
|✘
|✔
|✘
|Increase [[ESR]], increased [[LDH]]
|[[Night sweats]], constant fatigue
|-
| style="background:#DCDCDC;" align="center" + |[[Brucellosis]]
|✔
|✔
|✘
|✔
|✔
|✔
|✔
|✔
|[[Lymphocytosis|Relative lymphocytosis]]
|[[Night sweats]], often with characteristic smell, likened to wet hay
|-
| style="background:#DCDCDC;" align="center" + |[[Typhoid fever]]
|✔
|✔
|✘
|✔
|✘
|✘
|✔
|✔
|Decreased [[hemoglobin]]
|Incremental increase in temperature initially and than sustained [[fever]] as high as 40°C (104°F)
|-
| style="background:#DCDCDC;" align="center" + |[[Malaria]]
|✔
|✘
|✔
|✔
|✘
|✘
|✔
|✔
|Microcytosis,
elevated [[LDH]]
|"Tertian" fever: paroxysms occur every second day
|-
| style="background:#DCDCDC;" align="center" + |[[Tuberculosis]]
|✔
|✔
|✘
|✔
|✔
|✔
|✘
|✔
|Mild normocytic [[anemia]], [[hyponatremia]], and
[[hypercalcemia]]
|[[Night sweats]], constant fatigue
|-
| style="background:#DCDCDC;" align="center" + |[[Mumps]]
|✔
|✘
|✘
|✘
|✘
|✔
|✘
|✘
|[[Lymphocytosis|Relative lymphocytosis]], serum [[amylase]]<nowiki/>elevated
|[[Parotid gland|Parotid]]<nowiki/>swelling/tenderness
|-
| style="background:#DCDCDC;" align="center" + |[[Rheumatoid arthritis]]
|✘
|✔
|✘
|✘
|✘
|✘
|✘
|✔
|[[ESR]] and [[CRP]] elevated, positive [[rheumatoid factor]]
|Morning stiffness
|-
| style="background:#DCDCDC;" align="center" + |[[SLE]]
|✘
|✔
|✘
|✔
|✔
|✘
|✘
|✔
|[[ESR]] and [[CRP]] elevated, positive [[ANA]]
|[[Fatigue]]
|-
| style="background:#DCDCDC;" align="center" + |[[Human Immunodeficiency Virus|HIV]]
|✘
|✘
|✘
|✔
|✔
|✔
|✘
|✔
|
|Constant fatigue
|}


==Other Differentials==
The differentials include the following:<ref name="pmid18163139">{{cite journal |vauthors=Ejilemele AA, Nwauche CA, Ejele OA |title=Pattern of abnormal liver enzymes in HIV patients presenting at a Nigerian Tertiary Hospital |journal=Niger Postgrad Med J |volume=14 |issue=4 |pages=306–9 |date=December 2007 |pmid=18163139 |doi= |url=}}</ref><ref name="pmid1579936">{{cite journal |vauthors=Gøransson LG, Omdal R, Husby G |title=[Adult-onset Still's disease. Diagnosis, differential diagnosis and treatment] |language=Norwegian |journal=Tidsskr. Nor. Laegeforen. |volume=112 |issue=9 |pages=1155–5 |date=March 1992 |pmid=1579936 |doi= |url=}}</ref><ref name="pmid21734024">{{cite journal |vauthors=Hatakka A, Klein J, He R, Piper J, Tam E, Walkty A |title=Acute hepatitis as a manifestation of parvovirus B19 infection |journal=J. Clin. Microbiol. |volume=49 |issue=9 |pages=3422–4 |date=September 2011 |pmid=21734024 |pmc=3165617 |doi=10.1128/JCM.00575-11 |url=}}</ref><ref name="pmid25780346">{{cite journal |vauthors=Yaguchi D, Marui N, Matsuo M |title=Three Adult Cases of HPV-B19 Infection with Concomitant Leukopenia and Low Platelet Counts |journal=Clin Med Insights Case Rep |volume=8 |issue= |pages=19–22 |date=2015 |pmid=25780346 |pmc=4345940 |doi=10.4137/CCRep.S18085 |url=}}</ref><ref name="pmid11810534">{{cite journal |vauthors=Díaz F, Collazos J |title=Hepatic dysfunction due to parvovirus B19 infection |journal=J. Infect. Chemother. |volume=6 |issue=1 |pages=63–4 |date=March 2000 |pmid=11810534 |doi=10.1007/s101560000023 |url=}}</ref><ref name="urlwatermark.silverchair.com">{{cite web |url=https://watermark.silverchair.com/22-5-783.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAaUwggGhBgkqhkiG9w0BBwagggGSMIIBjgIBADCCAYcGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMNepsAzlRiawaxgMCAgEQgIIBWCcwAN4r_jjoL6cD8qOBCgCIgpagHIemSBzmiP_c08L34mY51H7ulShPj9n2yDVBVRols0OgZEIsKVl8kHD_89enHvhFrJOIh8cF7GxZ_AXULME_iReJXr37VWLU5bWFrtZHafAg_cvOdP8mr5u5K8TzGLBtd5VfQb2MGyXZhz-hpKGZbfMr33rJio00VHcFn_aS5wjB-h6fny_rsD4fwLj5xSWNB0_JEYq9g0-mS7y_igwhIZlismSrS4-svrkx46SDLpKqkTrJmImyDBGTj1Qi3INV8KT66j4j6z2wju7sRKvWxQAsoJhN6D8zxx5PQkth3gLDch3wLW_sn9o8q7sBlO25ONobKarrln8nwsS4f-9wHmPs82ZySggX4SgVtrMn6tr3lMVcroGV9fjOIcQQuk_KRq01ErxBdPtynPVbAZhmInGIJ0_LYqvOKplDpNnMHZZaEQYd |title=watermark.silverchair.com |format= |work= |accessdate=}}</ref><ref name="pmid23355575">{{cite journal |vauthors=Shetty RK, Vivek G, Naha K, Bekkam S |title=Right-sided infective endocarditis presenting with purpuric skin rash and cardiac failure in a patient without fever |journal=BMJ Case Rep |volume=2013 |issue= |pages= |date=January 2013 |pmid=23355575 |pmc=3603787 |doi=10.1136/bcr-2012-007841 |url=}}</ref><ref name="pmid23133445">{{cite journal |vauthors=Aucott JN, Crowder LA, Yedlin V, Kortte KB |title=Bull's-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans |journal=Dermatol Res Pract |volume=2012 |issue= |pages=451727 |date=2012 |pmid=23133445 |pmc=3485866 |doi=10.1155/2012/451727 |url=}}</ref><ref name="pmid21772606">{{cite journal |vauthors=Karaali Z, Baysal B, Poturoglu S, Kendir M |title=Cutaneous manifestations in brucellosis |journal=Indian J Dermatol |volume=56 |issue=3 |pages=339–40 |date=May 2011 |pmid=21772606 |pmc=3132922 |doi=10.4103/0019-5154.82505 |url=}}</ref><ref name="pmid18843212">{{cite journal |vauthors=La Spada E, Micalizzi A, La Spada M, Quartarano P, Nugara G, Soresi M, Affronti M, Montalto G |title=[Abnormal liver function in brucellosis] |language=Italian |journal=Infez Med |volume=16 |issue=3 |pages=148–53 |date=September 2008 |pmid=18843212 |doi= |url=}}</ref><ref name="pmid17235095">{{cite journal |vauthors=French P |title=Syphilis |journal=BMJ |volume=334 |issue=7585 |pages=143–7 |date=January 2007 |pmid=17235095 |pmc=1779891 |doi=10.1136/bmj.39085.518148.BE |url=}}</ref><ref name="urlSyphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features">{{cite web |url=http://cmr.asm.org/content/12/2/187.full |title=Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features |format= |work= |accessdate=}}</ref><ref name="pmid24700957">{{cite journal |vauthors=Baveja S, Garg S, Rajdeo A |title=Syphilitic hepatitis: an uncommon manifestation of a common disease |journal=Indian J Dermatol |volume=59 |issue=2 |pages=209 |date=March 2014 |pmid=24700957 |pmc=3969699 |doi=10.4103/0019-5154.127711 |url=}}</ref><ref name="pmid1600010">{{cite journal |vauthors=Mawhorter SD, Effron D, Blinkhorn R, Spagnuolo PJ |title=Cutaneous manifestations of toxoplasmosis |journal=Clin. Infect. Dis. |volume=14 |issue=5 |pages=1084–8 |date=May 1992 |pmid=1600010 |doi= |url=}}</ref><ref name="pmid24662942">{{cite journal |vauthors=Flegr J, Prandota J, Sovičková M, Israili ZH |title=Toxoplasmosis--a global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries |journal=PLoS ONE |volume=9 |issue=3 |pages=e90203 |date=2014 |pmid=24662942 |pmc=3963851 |doi=10.1371/journal.pone.0090203 |url=}}</ref><ref name="pmid21887062">{{cite journal |vauthors=Furtado JM, Smith JR, Belfort R, Gattey D, Winthrop KL |title=Toxoplasmosis: a global threat |journal=J Glob Infect Dis |volume=3 |issue=3 |pages=281–4 |date=July 2011 |pmid=21887062 |pmc=3162817 |doi=10.4103/0974-777X.83536 |url=}}</ref><ref name="pmid10808314">{{cite journal |vauthors=Ripert C |title=[Reactive hypereosinophilia in parasitic diseases] |language=French |journal=Rev Prat |volume=50 |issue=6 |pages=602–7 |date=March 2000 |pmid=10808314 |doi= |url=}}</ref><ref name="pmid21569516">{{cite journal |vauthors=Alvarado-Esquivel C, Torres-Berumen JL, Estrada-Martínez S, Liesenfeld O, Mercado-Suarez MF |title=Toxoplasma gondii infection and liver disease: a case-control study in a northern Mexican population |journal=Parasit Vectors |volume=4 |issue= |pages=75 |date=May 2011 |pmid=21569516 |pmc=3105944 |doi=10.1186/1756-3305-4-75 |url=}}</ref><ref name="pmid5339237">{{cite journal |vauthors=Han T, Stutzman L |title=Mode of spread in patients with localized malignant lymphoma |journal=Arch. Intern. Med. |volume=120 |issue=1 |pages=1–7 |date=July 1967 |pmid=5339237 |doi= |url=}}</ref><ref name="pmid23071471">{{cite journal |vauthors=Saeed-Abdul-Rahman I, Al-Amri AM |title=Castleman disease |journal=Korean J Hematol |volume=47 |issue=3 |pages=163–77 |date=September 2012 |pmid=23071471 |pmc=3464333 |doi=10.5045/kjh.2012.47.3.163 |url=}}</ref><ref name="pmid230714712">{{cite journal |vauthors=Saeed-Abdul-Rahman I, Al-Amri AM |title=Castleman disease |journal=Korean J Hematol |volume=47 |issue=3 |pages=163–77 |date=September 2012 |pmid=23071471 |pmc=3464333 |doi=10.5045/kjh.2012.47.3.163 |url=}}</ref><ref name="pmid21063526">{{cite journal |vauthors=Papadavid E, Panayiotides I, Dalamaga M, Katoulis A, Economopoulos T, Stavrianeas N |title=Cutaneous involvement in angioimmunoblastic T-cell lymphoma |journal=Indian J Dermatol |volume=55 |issue=3 |pages=279–80 |date=2010 |pmid=21063526 |pmc=2965920 |doi=10.4103/0019-5154.70704 |url=}}</ref><ref name="pmid26120552">{{cite journal |vauthors=Brockow K, Przybilla B, Aberer W, Bircher AJ, Brehler R, Dickel H, Fuchs T, Jakob T, Lange L, Pfützner W, Mockenhaupt M, Ott H, Pfaar O, Ring J, Sachs B, Sitter H, Trautmann A, Treudler R, Wedi B, Worm M, Wurpts G, Zuberbier T, Merk HF |title=Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM) |journal=Allergo J Int |volume=24 |issue=3 |pages=94–105 |date=2015 |pmid=26120552 |pmc=4479479 |doi=10.1007/s40629-015-0052-6 |url=}}</ref><ref name="pmid15745878">{{cite journal |vauthors=Medlej-Hashim M, Loiselet J, Lefranc G, Mégarbané A |title=[Familial Mediterranean Fever (FMF): from diagnosis to treatment] |language=French |journal=Sante |volume=14 |issue=4 |pages=261–6 |date=2004 |pmid=15745878 |doi= |url=}}</ref><ref name="pmid27142780">{{cite journal |vauthors=Zhang S |title=Natural history of mevalonate kinase deficiency: a literature review |journal=Pediatr Rheumatol Online J |volume=14 |issue=1 |pages=30 |date=May 2016 |pmid=27142780 |pmc=4855321 |doi=10.1186/s12969-016-0091-7 |url=}}</ref>


 
{| class="wikitable"
 
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Category of Disease
 
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
 
! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and symptoms
 
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory findings
==Differential Diagnosis==
|-
{{ddx0|Hodgkin's lymphoma}}
| rowspan="2" |'''Fever'''
{{ddx1|Sarcoidosis}}
| rowspan="2" |'''Fatigue'''
{{ddx1|Lymphocytic lymphoma}}
| rowspan="2" |'''Arthralgia'''
{{ddx1|Miliary tuberculosis}}
| rowspan="2" |'''Myalgia'''
{{ddx1|Infectious mononucleosis}}
| rowspan="2" |'''Soft tissue swelling/serositis'''
{{ddx1|Thoracic aortic aneurysm}}
| rowspan="2" |'''Skin rash'''
{{ddx1|Substernal goiter}}
| rowspan="2" |'''Weight loss'''
{{ddx1|Thymoma}}
| rowspan="2" |'''Dyspnea'''
{{ddx1|Actinomycosis}}
| rowspan="2" |'''Sore throat'''
{{ddx1|Chronic lymphocytic leukemia}}
| rowspan="2" |'''Lymphadenopathy'''
{{ddx1|Superior vena cava syndrome}}
| rowspan="2" |'''Complete blood count (CBC)'''
{{ddx1|Unicentric Castleman disease}}
| rowspan="2" |'''Liver function tests (LFTs)'''
{{ddx1|Adult Still disease}}
| colspan="2" |
{{ddx1|Small cell lung carcinoma}}
=== Inflammatory markers ===
{{ddx1|Malignant histiocytosis}}
| colspan="6" |
 
=== Autoantibodies ===
----
|
 
=== Diagnostic tests ===
{{ddx|Hodgkin's lymphoma}}
|-
 
|'''Erythrocyte sedimentation rate (ESR)'''
=====Clinical manifestations=====
|'''C- reactive protein (CRP)'''
* Mental nerve neuropathy
|'''Anti-nuclear antibodies (ANA)'''
* Alcohol intolerance
|'''Rheumatoid factor (RF)'''
* Exfoliative dermatitis 
|'''Anti- glomerular basement membrane (anti-GBM)'''
* Epitrochlear lymph node enlargement
|'''Anti-dsDNA'''
* Inguinal lymph node enlargement
|'''Anti-Jo1/ Anti Mi2'''
* Hepatomegaly
|'''ANCA'''
* Liver mass
|
* Superior vena cava obstruction
|-
* Inferior vena cava obstruction
| rowspan="9" |
* Femoral lymph node enlargement
=== Infections ===
* Popliteal lymph node enlargement
| [[Human Immunodeficiency Virus (HIV)|'''HIV''']]
* Pemberton sign positive
|<nowiki>+</nowiki>
* Pel-Ebstein fever
|<nowiki>+</nowiki>
* Chylous ascites
|<nowiki>+</nowiki>
* Axillary lymph node enlargement
|<nowiki>+</nowiki>
* Erythema multiforme
|<nowiki>+/-</nowiki>
* Erythema nodosum
|<nowiki>-</nowiki>
* Hepatosplenomegaly
|<nowiki>+</nowiki>
* Mesenteric lymph node enlargement
|<nowiki>+/-</nowiki>
* Paraplegia
|<nowiki>+ /-</nowiki>
* Pruritus
|<nowiki>+</nowiki>
* Spinal cord compression
|
* Spleen enlargement
* [[Leukopenia]]
* Urinary tract obstruction
* [[Anemia]]
* Generalized diffuse lymph node enlargement
* [[Thrombocytopenia]]
* Airway compression or obstruction
|
* Cryptococcosis
* [[Alanine transaminase|ALT]]'''↑'''
* Bone pain
* [[Aspartate transaminase|AST]]'''↑'''
* Cervical lymph node enlargement
|'''↑'''
* Recurrent fever 
|'''↑'''
* Recurrent infection
| -
* Fixed lymph node
| -
* Neck mass
| -
* Night sweats
| -
* Malaise
| -
* Supraclavicular lymph node enlargement
| -
* Sweating increase
|
* Fever unknown origin
|-
* Remittent fever
| ''[[Herpesviridae|'''Herpesviridae''']]''
* Painless lymphadenopathy
|<nowiki>+</nowiki>
* Regional lymph node enlargement
|<nowiki>+</nowiki>
 
|<nowiki>+</nowiki>
=====Laboratory abnormalities=====
|<nowiki>+</nowiki>
* Nucleated red cells
|<nowiki>+</nowiki>
* Hypogammaglobulinemia
|
* Pancytopenia
* Papular or vesicular
* Lymphocytes decreased
* [[Erythematous]] base
* Granulomas on biopsy
* Painful
 
|<nowiki>-</nowiki>
=====Radiographic features=====
|<nowiki>-</nowiki>
* Retroperitoneal lymph node enlargement
|<nowiki>+/-</nowiki>
* Biliary tract dilatation on abdominal ultrasound
|<nowiki>+</nowiki>
* Bone lesion
|
* Mediastinal mass,adenopathy, or widening on chest xray 
* [[Leukocytosis]]
* Middle mediastinal mass on chest xray 
|<nowiki>-</nowiki>
* Mediastinal lymph node enlargement
|'''↑'''
* Anterior mediastinal mass on chest radiograph
|'''↑'''
* Increased uptake on abdomen gallium scan
|<nowiki>-</nowiki>
* Ivory vertebra
|<nowiki>-</nowiki>
* Increased uptake on mediastinum gallium scan
|<nowiki>-</nowiki>
 
|<nowiki>-</nowiki>
----
| -
 
| -
{{ddx|Sarcoidosis}}
|
 
|-
=====Clinical manifestations=====
| '''[[Measles]]'''
* Corneal deposit
|<nowiki>+</nowiki>
* Corneal opacity
|<nowiki>+</nowiki>
* Parotid gland swelling
|<nowiki>+</nowiki>
* Polyneuropathy
|<nowiki>+</nowiki>
* Cranial nerve paralysis
|<nowiki>-</nowiki>
* Airway compression or obstruction
|
* Retinal granuloma
* 3-5 days after fever
* Erythema nodosum
* [[Erythematous]] [[maculopapular]] rash starts on face spreads to trunk and [[extremities]] (centrifugal)
* Uveitis
|<nowiki>-</nowiki>
* Ankle pain
|<nowiki>-</nowiki>
* Facial paralysis
|<nowiki>+</nowiki>
* Salivary gland swelling
|<nowiki>+</nowiki>
* Massive splenomegaly
|
* Cryptococcosis
* [[Leukocytosis]]
* Generalized rash, papules (elevated, <0.5cm)
|<nowiki>-</nowiki>
* Iridocyclitis
|'''↑'''
* Iritis
|'''↑'''
* Dry cough
|<nowiki>-</nowiki>
* Night sweats
|<nowiki>-</nowiki>
* Spleen enlargement
|<nowiki>-</nowiki>
* Bilateral uveitis 
|<nowiki>-</nowiki>
* Generalized diffuse lymph node enlargement
| -
* Polyarthritis
| -
 
|
=====Laboratory abnormalities=====
|-
* Hypercalcemia
| '''[[Hepatitis|Viral hepatitis]]'''
* Increased lymphocytes in pleural effusion
|<nowiki>+</nowiki>
* Decreased Lymphocytes
|<nowiki>+</nowiki>
* Hypercalciuria
|<nowiki>-</nowiki>
* Mild-moderate elevation  of alkaline phosphatase 
|<nowiki>+/-</nowiki>
* PFT's: restrictive defect
|<nowiki>-</nowiki>
* PFT's: diffusion capacity decreased
|<nowiki>-</nowiki>
* Elevated serum angiotensin-converting enzyme
|<nowiki>+/-</nowiki>
* Increased vitamin D, 1,25-dihydroxy
|<nowiki>-</nowiki>
 
|<nowiki>-</nowiki>
=====Radiographic features=====
|<nowiki>+/-</nowiki>
* Heart conduction abnormality on electrocardiographic
|
* Atrioventricular block
* [[Leukocytosis]]
* Retroperitoneal lymph node enlargement
|
* Lung cyst on chest radiography
* [[Alanine transaminase|ALT]]'''↑'''
* Interstitial infiltrate ( incl. reticulonodular )on chest radiography
* [[Aspartate transaminase|AST]]'''↑'''
* Increased mediastinal uptake on gallium scan
|'''↑'''
* Increased lung uptake on gallium scan
|'''↑'''
* Mediastinal lymph node enlargement
|<nowiki>-</nowiki>
* Bone marrow granulomas
|<nowiki>-</nowiki>
* Mediastinal mass, adenopathy, or widening on chest radiography
|<nowiki>-</nowiki>
* Granulomas on biopsy
|<nowiki>-</nowiki>
* Hilar lymph node enlargement on chest radiography
| -
 
| -
----
|
 
|-
{{ddx|Lymphocytic lymphoma}}
| ''[[Parvovirus B19|'''Parvovirus B19''']]''
 
|<nowiki>+</nowiki>
=====Clinical manifestations=====
|<nowiki>+</nowiki>
* Mental nerve neuropathy
|<nowiki>+</nowiki>
* Exfoliative dermatitis
|<nowiki>+/-</nowiki>
* Lower extremity paralysis
|<nowiki>-</nowiki>
* Gout
|
* Esophageal candidiasis
* Slapped cheek rash
* Abdominal mass
|<nowiki>-</nowiki>
* Biliary tract obstruction
|<nowiki>-</nowiki>
* Breast mass
|<nowiki>-</nowiki>
* Epitrochlear lymph node enlargement
|<nowiki>+</nowiki>
* Erythema multiforme
|
* Erythema nodosum
* [[Leukopenia]]
* Esophageal obstruction
* [[Aplastic anemia]] (low [[reticulocyte]] count)
* Facial edema
* [[Thrombocytopenia]]
* Gastric obstruction
|
* Thyroid nodule
* [[Alanine transaminase|ALT]]'''↑'''
* Hepatosplenomegaly
* [[Aspartate transaminase|AST]]'''↑'''
* Intestinal obstruction
|'''↑'''
* Intussusception
|'''↑'''
* Liver mass
|<nowiki>-</nowiki>
* Mesenteric lymph node enlargement
|<nowiki>-</nowiki>
* Mucous membrane bleeding
|<nowiki>-</nowiki>
* Night sweats
|<nowiki>-</nowiki>
* Paraplegia
| -
* Pruritus
| -
* Anergy
|
* Spinal cord compression
|-
* Stool clay color
|'''[[Infective endocarditis]]'''
* Stool color yellow
|<nowiki>+</nowiki>
* Superior vena cava obstruction
|<nowiki>+</nowiki>
* Supraclavicular lymph node enlargement
|<nowiki>+</nowiki>
* Testicular mass
|<nowiki>+/-</nowiki>
* Urinary tract obstruction
|<nowiki>-</nowiki>
* Inferior vena cava obstruction
|
* Generalized diffuse lymph node enlargement
* [[Purpuric]]
* Massive splenomegaly 
|<nowiki>+/-</nowiki>
* Femoral lymph node enlargement
|<nowiki>+</nowiki>
* Popliteal lymph node enlargement
|<nowiki>-</nowiki>
* Airway compression or obstruction
|<nowiki>+</nowiki>
* Cryptococcosis
|
* Recurrent infection
* [[Leukocytosis]]
* Fixed lymph node
|<nowiki>-</nowiki>
* Neck mass
|'''↑'''
* Spleen enlargement
|'''↑'''
* Fever unknown origin
|<nowiki>-</nowiki>
* Regional lymph node enlargement
|<nowiki>-</nowiki>
* Painless lymphadenopathy
|<nowiki>-</nowiki>
* Cancer
|<nowiki>-</nowiki>
* Lymphoma
| -
* Non-Hodgkin lymphoma
| -
 
|Blood cultures, ultrasonography
=====Laboratory abnormalities=====
|-
* Extreme hypercalcemia  (>14 mg/dl)
|'''[[Borreliosis]], [[Brucellosis]], [[Yersiniosis]]'''
* Prolonged bleeding time
|<nowiki>+</nowiki>
* Markedly increased ESR 
|<nowiki>+</nowiki>
* Hypogammaglobulinemia
|<nowiki>+</nowiki>
* Pancytopenia
|<nowiki>+</nowiki>
* Lymphocytes decreased
|<nowiki>-</nowiki>
* Pleural effusion (Exudate) 
|
* Bone marrow plasma cells increased
* Target rash ([[Borrelia]])
* Lymphocytes increased in pleural effusion 
* Diffuse [[maculopapular]] ([[Brucellosis]])
* Pleural effusion (Chylous)
* [[Erythema nodosum]] ([[Yersiniosis]])
* Malignant ascites
|<nowiki>-</nowiki>
* Cryoglobulinemia
|<nowiki>-</nowiki>
* Vitamin D, 1,25-dihydroxy increased
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
=====Radiographic features=====
|
* Bladder mass or abnormal shape on IVP
* [[Leukocytosis]]
* Bone destruction
|
* Kidney mass
* [[Alanine transaminase|ALT]]'''↑'''
* Mediastinal lymph node enlargement
* [[Aspartate transaminase|AST]]'''↑'''
* Bone lesion
|'''↑'''
* Retroperitoneal lymph node enlargement
|'''↑'''
* Mediastinal mass, adenopathy, or widening on chest radiography
|<nowiki>-</nowiki>
* Anterior mediastinal mass on chest radiography
|<nowiki>-</nowiki>
* Biliary tract dilatation on abdominal ultrasound
|<nowiki>-</nowiki>
* Increased mediastinal uptake on gallium scan
|<nowiki>-</nowiki>
* Increased abdominal uptake on gallium scan
| -
| -
----
|Serology, PCR
 
|-
{{ddx|Miliary tuberculosis}}
|'''[[Syphilis]] and [[Jarisch-Herxheimer reaction]]'''
 
|<nowiki>+</nowiki>
=====Clinical manifestations=====
|<nowiki>+</nowiki>
* Prison inmate
|<nowiki>+</nowiki>
* Retinal granuloma
|<nowiki>+</nowiki>
* Erythema nodosum
|<nowiki>-</nowiki>
* Travel history (Haiti)
|
* Immunosuppressive therapy
* Non-pruritic
* Severe weight loss
* [[Macular]]
* Corticosteroid use
* On palms and soles
* Pleuritic chest pain
* Round
* Progressive dyspnea
* Seen in [[secondary syphilis]]
* Fever unknown origin
* [[Penis|Penile]] [[ulceration]] (painless)
* Retinitis
|<nowiki>-</nowiki>
* Tuberculosis exposure
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
=====Laboratory abnormalities=====
|<nowiki>+</nowiki>
* Pancytopenia
|
* PPD positive
* [[Leukocytosis]]
* Nucleated red cells
|
* Bone marrow granulomas
* [[Alanine transaminase|ALT]]'''↑''' (Uncommon)
* AFB smear positive
* [[Aspartate transaminase|AST]]'''↑''' (Uncommon)
* Granulomas on biopsy
|'''↑'''
 
|'''↑'''
=====Radiographic features=====
|<nowiki>-</nowiki>
* Increased abdominal uptake on gallium scan
|<nowiki>-</nowiki>
* Multiple hypodense liver lesions on abdominal CT
|<nowiki>-</nowiki>
* Multiple non-calcified pulmonary nodules on chest radiography
|<nowiki>-</nowiki>
 
| -
----
| -
 
|Serology, PCR
{{ddx|Infectious mononucleosis}}
|-
 
|'''[[Toxoplasmosis]]'''
=====Clinical manifestations=====
|<nowiki>+</nowiki>
* Optic neuritis
|<nowiki>+</nowiki>
* Epitrochlear lymph node enlargement
|<nowiki>-</nowiki>
* Periorbital edema
|<nowiki>+</nowiki>
* Pharyngeal petechia
|<nowiki>-</nowiki>
* Spleen enlargement
|
* Spleen palpable
* [[Maculopapular]]
* Tonsillitis
* Palms and soles
* Left upper quadrant abdominal tenderness
|<nowiki>-</nowiki>
* Axillary lymph node enlargement
|<nowiki>-</nowiki>
* Inguinal lymph node enlargement
|<nowiki>+</nowiki>
* Pesenteric lymph node enlargement
|<nowiki>+</nowiki>
* Pharyngeal exudate
|
* Pharyngeal erythema
* [[Leukocytosis]] (eosinophilia)
* Spleen tenderness
|
* Tonsillar exudate
|
* Generalized diffuse lymph node enlargement
|
* Cervical lymph node enlargement
|<nowiki>-</nowiki>
* Pharyngeal swelling
|<nowiki>-</nowiki>
* Sore throat
|<nowiki>-</nowiki>
 
|<nowiki>-</nowiki>
=====Laboratory abnormalities=====
| -
* Marked elevationSGPT (ALT)
| -
* SGPT (ALT) elevated
|Serology, PCR
* Lymphocytes increased
|-
* Atypical lymphocytes increased
|
* Heterophile antibody positive
| colspan="22" |
* Monocytes increased
|-
* Epstein-Barr virus titre positive
| rowspan="3" |
 
=== Neoplasia ===
----
|'''[[Malignant lymphoma]]'''
 
|<nowiki>+</nowiki>
{{ddx|Thoracic aortic aneurysm}}
|<nowiki>+</nowiki>
   
|<nowiki>-</nowiki>
=====Clinical manifestations=====
|<nowiki>+/-</nowiki>
* Cocaine use
|<nowiki>+/-</nowiki>
* Turner syndrome
|
* Pemberton sign positive
* Purplish scaly rash in cases of [[cutaneous]] [[lymphoma]]
* Marfan syndrome
|<nowiki>+</nowiki>
* Aortic valve regurgitation
|<nowiki>+ </nowiki>
* Superior vena cava obstruction
|<nowiki>-</nowiki>
* Ascending aortic dilation
|<nowiki>+</nowiki>
|
=====Radiographic features=====
* [[Anemia of chronic disease]]
* Anterior mediastinal mass on chest radiography
|
* Middle mediastinal mass on chest radiography
* In case of [[liver]] [[metastasis]] ([[Non-Hodgkin lymphoma]]):
* Posterior mediastinal mass on chest radiography 
** [[Alanine transaminase|ALT]]'''↑'''
* Aorta prominent or enlarged on chest radiography
** [[Aspartate transaminase|AST]]'''↑'''
 
|'''↑'''
----
|'''↑'''
 
|<nowiki>-</nowiki>
{{ddx|Substernal goiter}}
|<nowiki>-</nowiki>
   
|<nowiki>-</nowiki>
=====Clinical manifestations=====
|<nowiki>-</nowiki>
* Upper extremity edema
| -
* Chest mass
| -
* Neck mass
|CT, PET/CT, Bone marrow examination, lymph node biopsy
* Thyroid enlargement
|-
* Tracheal compression
|'''[[Castleman's disease|Multicentric Castleman disease]]'''
* Pemberton sign positive
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
=====Laboratory abnormalities=====
|<nowiki>-</nowiki>
* TSH elevated
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
=====Radiographic features=====
|<nowiki>-</nowiki>
*  Mediastinal mass, adenopathy, or widening on chest radiograph
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
----
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
{{ddx|Thymoma}}
|
 
* [[Anemia]]
=====Clinical manifestations=====
* [[Thrombocytopenia]]
* Bulbar palsy
|<nowiki>-</nowiki>
* Facial candida infection
|'''↑'''
* Facial cyanosis
|'''↑'''
* Jugular venous distention
|<nowiki>-</nowiki>
* Mouth candida infection
|<nowiki>-</nowiki>
* Superior vena cava obstruction
|<nowiki>-</nowiki>
* Diplopia
|<nowiki>-</nowiki>
* Pemberton sign positive
| -
 
| -
=====Laboratory abnormalities=====
|Lymph node biopsy
* Pancytopenia
|-
* Antistriational antibodies
|'''[[Angioimmunoblastic T-cell lymphoma|Angioimmunoblastic T cell lymphoma]]'''
 
|<nowiki>+</nowiki>
=====Radiographic features=====
|<nowiki>+</nowiki>
* Mediastinal mass, adenopathy, or widening on chest radiograph
|<nowiki>-</nowiki>
* Anterior mediastinal mass on chest radiograph 
|<nowiki>-</nowiki>
 
|<nowiki>-</nowiki>
----
|
 
* [[Maculopapular]] eruption on the trunk mimicking [[Erythema toxicum|toxic erythema]]
{{ddx|Actinomycosis}}
|<nowiki>+</nowiki>
 
|<nowiki>-</nowiki>
=====Clinical manifestations=====
|<nowiki>-</nowiki>
* Tongue mass
|<nowiki>+</nowiki>
* Trismus
|
* Pericardial constriction
* [[Lymphocytosis]]
* Pharyngeal swelling
|
* Pharyngeal tenderness
* [[Alanine transaminase|ALT]]'''↑'''
* Abdominal fistula
* [[Aspartate transaminase|AST]]'''↑'''
* Bronchial fistula
|'''↑'''
* Empyema
|↑
* Lung abscess
|<nowiki>-</nowiki>
* Right lower quadrant abdominal mass
|<nowiki>-</nowiki>
* Chest wall suppuration
|<nowiki>-</nowiki>
* Gingival fistula
|<nowiki>-</nowiki>
* Chest wall fistula
| -
* Gingival swelling
| -
* Gingival tenderness
|Lymph node biopsy
* Jaw induration
|-
* Mandibular swelling
|
 
| colspan="22" |
=====Laboratory abnormalities=====
|-
* Branching Gram-positive bacilli on Gram stain
|
* Sulfur granule
=== Drug hypersensitivity ===
 
|Drug reaction with eosinophilia and systemic symptoms
=====Radiographic features=====
|<nowiki>+</nowiki>
* Mediastinal mass, adenopathy, or widening on chest radiography 
|<nowiki>+</nowiki>
* Intracardiac mass on echocardiogram
|<nowiki>+</nowiki>
* Hepatic cyst(s)
|<nowiki>+</nowiki>
 
|<nowiki>+/-</nowiki>
----
|
 
* [[Urticaria|Utricaria]] (Immediate type)
{{ddx|Chronic lymphocytic leukemia}}
* [[Maculopapular]] (Delayed type)
 
|<nowiki>-</nowiki>
=====Clinical manifestations=====
|<nowiki>+</nowiki>
* Skin infiltration
|<nowiki>-</nowiki>
* Sternal tenderness
|<nowiki>-</nowiki>
* Lymph node firmness
|
 
* [[Leukocytosis]] ([[eosinophilia]])
=====Laboratory abnormalities=====
|<nowiki>-</nowiki>
* Hemolysis
|'''↑'''
* Prolonged bleeding time
|'''↑'''
* Monoclonal gammopathy
|<nowiki>-</nowiki>
* Cryoglobulinemia
|<nowiki>-</nowiki>
* Marked increase of leukocytes
|<nowiki>-</nowiki>
* Clonal B-lymphocytes on flow cytometry
|<nowiki>-</nowiki>
* Lymphocytes increased
| -
 
| -
=====Radiographic features=====
|Eosinophil count, skin biopsy
* Mediastinal mass, adenopathy, or widening on chest radiography
|-
|
The following findings (if present) would make this disease less likely:
| colspan="22" |
* Left shift
|-
* Metamyelocytes increased
| rowspan="7" |Autoimmune conditions
 
|'''[[Systemic lupus erythematosus]]'''
----
|<nowiki>+</nowiki>
 
|<nowiki>+</nowiki>
{{ddx|Superior vena cava syndrome}}
|<nowiki>+</nowiki>
 
|<nowiki>+/-</nowiki>
=====Clinical manifestations=====
|<nowiki>+</nowiki>
* Stridor
|
* Facial erythema
* Butter-fly shaped [[erythematous]] malar rash that spares the [[nasolabial folds]]
* Forehead vein distention
* Coin-shaped [[erythematous]] rash on extremities or trunk
* Lymphoma
|<nowiki>+</nowiki>
* Tracheal displacement
|<nowiki>+</nowiki>
* Chest vein distention
|<nowiki>-</nowiki>
* Facial cyanosis
|<nowiki>+/-</nowiki>
* Collateral circulation increase
|
* Conjunctival edema
* [[Leukopenia]]
* Conjunctival vein distention
* [[Hemolytic anemia]]
* Upper extremity edema
* [[Thrombocytopenia]]
* Upper extremity erythema
|
* Head edema
* [[ALT]]'''↑'''
* Jugular venous distention with inspiration
* [[AST]]'''↑'''
* Lung tumor
|'''↑'''
* Extremity cyanosis
|'''↑'''
* Upper extremity vein distention
|<nowiki>+</nowiki>
* Facial edema
|<nowiki>+</nowiki>
* Neck edema
|<nowiki>-</nowiki>
* Jugular venous distention
|<nowiki>+</nowiki>
* Lung cancer
| -
* Upper extremity cyanosis
| -
* Facial vein distention
|Antinuclear autoantibodies
* Superior vena cava obstruction
|-
 
|'''Inflammatory myositis'''
=====Radiographic features=====
|<nowiki>+</nowiki>
* Mediastinal lymph node enlargement
|<nowiki>+</nowiki>
* Non-calcified pulmonary nodule (< 4 cm) on chest radiography
|<nowiki>-</nowiki>
* Mediastinal mass, adenopathy, or widening on chest radiography
|<nowiki>+ (weakness > pain)</nowiki>
 
|<nowiki>-</nowiki>
The following findings (if present) would exclude this disease:
|
* hepatojugular reflux
* [[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)
----
|<nowiki>-</nowiki>
 
|<nowiki>-</nowiki>
{{ddx|Unicentric Castleman disease}}
|<nowiki>-</nowiki>
   
|<nowiki>+/-</nowiki>
=====Radiographic features=====
|
* Mediastinal mass, adenopathy, or widening on chest radiography
* [[Leukocytosis]]
 
|<nowiki>-</nowiki>
----
|'''↑'''
 
|'''↑'''
{{ddx|Adult Still disease}}
|<nowiki>+/-</nowiki>
   
|<nowiki>+/-</nowiki>
=====Clinical manifestations=====
|<nowiki>-</nowiki>
* Ankylosis
|<nowiki>-</nowiki>
* Hepatosplenomegaly
| +
* Severe weight loss
| -
* Recurrent fever
|Idem, muscle biopsy
* Night sweats
|-
* Wrist pain
|[[Rheumatoid arthritis|'''Rheumatoid arthritis''']]
* Generalized diffuse lymph node enlargement
|<nowiki>+</nowiki>
* Fever unknown origin
|<nowiki>+</nowiki>
* Remittent fever
|<nowiki>+</nowiki>
* High grade fever
|<nowiki>-</nowiki>
* Polyarticular
|<nowiki>+</nowiki>
* Evanescent rash  
|
 
* [[Purpura]]
=====Laboratory abnormalities=====
* [[Ulcers]]
* Leukocytes, marked increase
|<nowiki>-</nowiki>
* ESR markedly increased
|<nowiki>+</nowiki>
* Serum ferritin greatly increased
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
The following findings (if present) would make this disease less likely:
|
* monoarticular
* [[Anemia of chronic disease]]
* [[Neutropenia]] ([[Felty's syndrome]])
The following findings (if present) would exclude this disease:
|<nowiki>-</nowiki>
* asymptomatic
|'''↑'''
 
|'''↑'''
----
|<nowiki>+/-</nowiki>
 
|<nowiki>+/-</nowiki>
{{ddx|Small cell lung carcinoma}}
|<nowiki>-</nowiki>
   
|<nowiki>-</nowiki>
=====Clinical manifestations=====
| -
* Acanthosis nigricans
| -
* Axillary lymph node enlargement
|Anti-citrullinated peptids autoantibodies, rheumatoid factor
* Axillary lymph node pain
|-
* Dysphagia
|'''[[Systemic vasculitides]]'''
* Esophageal obstruction
|<nowiki>+</nowiki>
* Heart tamponade
|<nowiki>+</nowiki>
* Pericardial effusion
|<nowiki>+</nowiki>
* Lower rib tenderness
|<nowiki>-</nowiki>
* Tracheal displacement
|<nowiki>+</nowiki>
* Hoarseness
|
* Digital clubbing
* Nasopharyngeal ulceration ([[Wegener's granulomatosis|Wegner's granulomatosis]])
* Airway compression or obstruction
* [[Erythematous]] rash on palms and soles ([[Kawasaki disease]])
* Pemberton sign positive
|<nowiki>-</nowiki>
* Velvet palms
|<nowiki>+/-</nowiki>
* Horner syndrome
|<nowiki>-</nowiki>
* Superior vena cava obstruction
|<nowiki>+/-</nowiki>
* Bone pain
|
* Spinal cord compression
* [[Leukocytosis]]
* Supraclavicular lymph node enlargement
|<nowiki>-</nowiki>
* Intracranial metastatic tumor
|'''↑'''
* Acute symmetrical peripheral neuropathy
|'''↑'''
* Hemoptysis
|<nowiki>-</nowiki>
* Right supraclavicular lymph node enlargement
|<nowiki>-</nowiki>
* Tobacco smoking
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
=====Laboratory abnormalities=====
| -
* Bone destruction
| +
* Unilateral diaphragm elevation on chest radiography
|ANCA, tissue biopsy, arteriography
* Non-calcified pulmonary nodule (< 4 cm) on chest radiography 
|-
* Mediastinal mass, adenopathy, or widening on chest radiography
|'''[[Familial mediterranean fever|Familial Mediterranean fever]]'''
* Pleural effusion
|<nowiki>+</nowiki>
* Pleural effusion (bloody)
|<nowiki>+</nowiki>
* Non-calcified pulmonary mass (>= 4 cm)on chest radiography
|<nowiki>+</nowiki>
* Hyponatremia
|<nowiki>+</nowiki>
* Bone marrow tumor cells
|<nowiki>+</nowiki>
* Serum calcitonin increased
|
* Hilar lymph node enlargement on chest radiography
* Red rash on [[lower extremities]] (ankles and knees)
|<nowiki>+</nowiki>
=====Radiographic features=====
|<nowiki>+ (due to pain)</nowiki>
* Normal on chest radiography
|<nowiki>-</nowiki>
* Normal on chest CT (contrast enhanced)
|<nowiki>+/-</nowiki>
 
|
----
* [[Leukocytosis]] (during acute flares)
 
|<nowiki>-</nowiki>
{{ddx|Malignant histiocytosis}}
|'''↑'''
 
|'''↑'''
=====Clinical manifestations=====
|<nowiki>-</nowiki>
* Tendon xanthoma
|<nowiki>-</nowiki>
* Xanthoma
|<nowiki>-</nowiki>
* Tuberous xanthoma
|<nowiki>-</nowiki>
* Planar xanthoma
|<nowiki>-</nowiki>
* Palmar planar xanthoma
|<nowiki>-</nowiki>
* Hepatosplenomegaly
|Familial history, MEFV gene analysis
* Spleen enlargement
|-
* Panniculitis
|'''[[Mevalonate kinase deficiency]]'''
* Generalized diffuse lymph node enlargement
|<nowiki>+</nowiki>
 
|<nowiki>+</nowiki>
=====Laboratory abnormalities=====
|<nowiki>+</nowiki>
* ESR markedly increased
|<nowiki>+</nowiki>
* Serum ferritin greatly increased
|<nowiki>-</nowiki>
* ESR mildly or moderately increased
|
* C-reactive protein elevated
* [[Maculopapular]] rash
* [[Aphthous ulcers]] (or [[stomatitis]]) 
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Leukocytosis]] (during acute flares)
|<nowiki>-</nowiki>
|'''↑'''
|'''↑'''
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Urinary mevalonic acid, mevalonate kinase analysis
|-
|'''[[Reactive arthritis]]'''
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Keratoderma blennorrhagica]] (palms, soles, scrotum)
* Circinate balanitis (penile)
|<nowiki>-</nowiki>
| + ([[Aortic insufficiency]])
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* [[Leukocytosis]]
|<nowiki>-</nowiki>
|'''↑'''
|'''↑'''
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|HLA B27, magnetic resonance imaging
|-
|
| colspan="22" |
|-
|
=== Miscellaneous ===
|'''[[Sarcoidosis]]'''
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* Waxy skin [[plaques]]
* Violaceous facial lesions
* [[Erythema nodosum]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* [[Lymphopenia]]
* [[Eosinophilia]]
|
* Normal [[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]
* [[Alkaline phosphatase|ALP]] '''↑ (infiltrative pattern)'''
|'''↑'''
|'''↑'''
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Lymph node/Lung biopsy
* ACE levels
* FDG-PET
|}


==References==
==References==
Line 563: Line 775:
[[Category:Rare diseases]]
[[Category:Rare diseases]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:primary care]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Immunology]]

Latest revision as of 22:13, 29 July 2020

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 anemia, hyponatremia, 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

  1. ↑ Ejilemele AA, Nwauche CA, Ejele OA (December 2007). "Pattern of abnormal liver enzymes in HIV patients presenting at a Nigerian Tertiary Hospital". Niger Postgrad Med J. 14 (4): 306–9. PMID 18163139.
  2. ↑ Gøransson LG, Omdal R, Husby G (March 1992). "[Adult-onset Still's disease. Diagnosis, differential diagnosis and treatment]". Tidsskr. Nor. Laegeforen. (in Norwegian). 112 (9): 1155–5. PMID 1579936.
  3. ↑ Hatakka A, Klein J, He R, Piper J, Tam E, Walkty A (September 2011). "Acute hepatitis as a manifestation of parvovirus B19 infection". J. Clin. Microbiol. 49 (9): 3422–4. doi:10.1128/JCM.00575-11. PMC 3165617. PMID 21734024.
  4. ↑ Yaguchi D, Marui N, Matsuo M (2015). "Three Adult Cases of HPV-B19 Infection with Concomitant Leukopenia and Low Platelet Counts". Clin Med Insights Case Rep. 8: 19–22. doi:10.4137/CCRep.S18085. PMC 4345940. PMID 25780346.
  5. ↑ Díaz F, Collazos J (March 2000). "Hepatic dysfunction due to parvovirus B19 infection". J. Infect. Chemother. 6 (1): 63–4. doi:10.1007/s101560000023. PMID 11810534.
  6. ↑ "watermark.silverchair.com" (PDF).
  7. ↑ Shetty RK, Vivek G, Naha K, Bekkam S (January 2013). "Right-sided infective endocarditis presenting with purpuric skin rash and cardiac failure in a patient without fever". BMJ Case Rep. 2013. doi:10.1136/bcr-2012-007841. PMC 3603787. PMID 23355575.
  8. ↑ Aucott JN, Crowder LA, Yedlin V, Kortte KB (2012). "Bull's-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans". Dermatol Res Pract. 2012: 451727. doi:10.1155/2012/451727. PMC 3485866. PMID 23133445.
  9. ↑ Karaali Z, Baysal B, Poturoglu S, Kendir M (May 2011). "Cutaneous manifestations in brucellosis". Indian J Dermatol. 56 (3): 339–40. doi:10.4103/0019-5154.82505. PMC 3132922. PMID 21772606.
  10. ↑ La Spada E, Micalizzi A, La Spada M, Quartarano P, Nugara G, Soresi M, Affronti M, Montalto G (September 2008). "[Abnormal liver function in brucellosis]". Infez Med (in Italian). 16 (3): 148–53. PMID 18843212.
  11. ↑ French P (January 2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
  12. ↑ "Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features".
  13. ↑ Baveja S, Garg S, Rajdeo A (March 2014). "Syphilitic hepatitis: an uncommon manifestation of a common disease". Indian J Dermatol. 59 (2): 209. doi:10.4103/0019-5154.127711. PMC 3969699. PMID 24700957.
  14. ↑ Mawhorter SD, Effron D, Blinkhorn R, Spagnuolo PJ (May 1992). "Cutaneous manifestations of toxoplasmosis". Clin. Infect. Dis. 14 (5): 1084–8. PMID 1600010.
  15. ↑ Flegr J, Prandota J, Sovičková M, Israili ZH (2014). "Toxoplasmosis--a global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries". PLoS ONE. 9 (3): e90203. doi:10.1371/journal.pone.0090203. PMC 3963851. PMID 24662942.
  16. ↑ Furtado JM, Smith JR, Belfort R, Gattey D, Winthrop KL (July 2011). "Toxoplasmosis: a global threat". J Glob Infect Dis. 3 (3): 281–4. doi:10.4103/0974-777X.83536. PMC 3162817. PMID 21887062.
  17. ↑ Ripert C (March 2000). "[Reactive hypereosinophilia in parasitic diseases]". Rev Prat (in French). 50 (6): 602–7. PMID 10808314.
  18. ↑ Alvarado-Esquivel C, Torres-Berumen JL, Estrada-Martínez S, Liesenfeld O, Mercado-Suarez MF (May 2011). "Toxoplasma gondii infection and liver disease: a case-control study in a northern Mexican population". Parasit Vectors. 4: 75. doi:10.1186/1756-3305-4-75. PMC 3105944. PMID 21569516.
  19. ↑ Han T, Stutzman L (July 1967). "Mode of spread in patients with localized malignant lymphoma". Arch. Intern. Med. 120 (1): 1–7. PMID 5339237.
  20. ↑ Saeed-Abdul-Rahman I, Al-Amri AM (September 2012). "Castleman disease". Korean J Hematol. 47 (3): 163–77. doi:10.5045/kjh.2012.47.3.163. PMC 3464333. PMID 23071471.
  21. ↑ Saeed-Abdul-Rahman I, Al-Amri AM (September 2012). "Castleman disease". Korean J Hematol. 47 (3): 163–77. doi:10.5045/kjh.2012.47.3.163. PMC 3464333. PMID 23071471.
  22. ↑ Papadavid E, Panayiotides I, Dalamaga M, Katoulis A, Economopoulos T, Stavrianeas N (2010). "Cutaneous involvement in angioimmunoblastic T-cell lymphoma". Indian J Dermatol. 55 (3): 279–80. doi:10.4103/0019-5154.70704. PMC 2965920. PMID 21063526.
  23. ↑ Brockow K, Przybilla B, Aberer W, Bircher AJ, Brehler R, Dickel H, Fuchs T, Jakob T, Lange L, Pfützner W, Mockenhaupt M, Ott H, Pfaar O, Ring J, Sachs B, Sitter H, Trautmann A, Treudler R, Wedi B, Worm M, Wurpts G, Zuberbier T, Merk HF (2015). "Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM)". Allergo J Int. 24 (3): 94–105. doi:10.1007/s40629-015-0052-6. PMC 4479479. PMID 26120552.
  24. ↑ Medlej-Hashim M, Loiselet J, Lefranc G, Mégarbané A (2004). "[Familial Mediterranean Fever (FMF): from diagnosis to treatment]". Sante (in French). 14 (4): 261–6. PMID 15745878.
  25. ↑ Zhang S (May 2016). "Natural history of mevalonate kinase deficiency: a literature review". Pediatr Rheumatol Online J. 14 (1): 30. doi:10.1186/s12969-016-0091-7. PMC 4855321. PMID 27142780.
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