Lymphomatoid granulomatosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Lymphamtoid granulomatosis must be differentiated from Bronchocentric granulomatosis and Churg-Strauss, Necrotizing sarcoid granulomatosis, Wegeners granulomatosis, Hodgkins disease, Non-hodgkin lymphoma, and Nasal angiocentric lymphoma

Differentiating Lymphamatoid granulomatosis from other Diseases

As Lymphamatoid granulomatosis manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtypes pulmonary being the most common. The sub types are the following:

• Pulmonary
• CNS
• Dermatologic

Pulmonary Lymphamatoid granulomatosis must be differentiated from other diseases that cause:

• Cough(non-productive, rarely hemoptysis can occur)
• Dyspnea
• Chest tightness

Other Symptoms that are asscociated with the pulmonary symptoms are:

• Malaise
• Weight loss
• Fatigue

From the symptoms listed above; Lymphamatoid granulomatosis is usually differtiated from the following diseases Bronchocentric granulomatosis and Churg-Strauss, Necrotizing sarcoid granulomatosis, Wegeners granulomatosis, Hodgkins disease, Non-hodgkin lymphoma, and Nasal angiocentric lymphoma.

In contrast, CNS lymphamatoid granulomatosis must be differentiated from other diseases that cause:

• Mental status changes
• Headaches
• Seizures
• Hemiparesis
• Ataxia

The differentials are the following CVA and Brain tumors or CNS lymphoma.

Finally Dermatologic Lymphamatoid granulomatosis must also be differtiated from other diseases that cause:

• Erythematous rash
• Macules
• Papules
• Plaques
• Subcutaneous nodules
• Larger ulcerated nodules

The differentials are the following Dermatomyositis, and Psoriasis

Differentiating Lymphamatoid Granulomatosis

On the basis of Cough, Dyspnea, and Chest tightness, Lymphamatoid granulomatosis must be differentiated from Bronchocentric granulomatosis and Churg-Strauss, Necrotizing sarcoid granulomatosis, Wegeners granulomatosis, Hodgkins disease, Non-hodgkin lymphoma, and Nasal angiocentric lymphoma.

Diseases	Clinical manifestations						Para-clinical findings							Gold standard	Additional findings
	Symptoms			Physical examination
							Lab Findings			Imaging			Histopathology
	Cough	Dyspnea	Chest tightness	Auscultation			Lab findings	Lab 2	Lab 3	X-ray	Imaging 2	Imaging 3
Bronchocentric granulomatosis	+	+	+	Wheezing Rales Rhonchi			eosinophilia			Usually solitary lesions that appear on chest Xray as atelectasis or consolidation, not nodules			Large and medium bronchi infiltrated by neutrophils, eosinophils and necrotic debris surrounded by foreign body giant cells Fragmented elastic tissue (with elastic stain) Also bronchiolitis obliterans No fibrinoid necrosis of vessels
Churg-Strauss syndrome	+	+	+	Wheezing Rales Rhonchi
Necrotizing sarcoid granulomatosis	+	+	-	Wheezing
Diseases	Symptom 1	Symptom 2	Symptom 3	Auscultation			Lab 1	Lab 2	Lab 3	Imaging 1	Imaging 2	Imaging 3	Histopathology	Gold standard	Additional findings
Wegeners granulomatosis
Hodgkin disease
Non-hodgkin lymphoma