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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Pathophysiology Symptoms Laboratory Findings
Immunochemistry Blood work Biospy/CT/CXR
Infections Bacterial Syphilis
  • It has an average incubation period of 3 - 12 weeks.
  • Spirochete penetrates intact mucous membrane or microscopic dermal abrasions and rapidly enters systemic circulation with the central nervous system being invaded during the early phase of infection.
  • The histopathological hallmark findings are endarteritis and plasma cell-rich infiltrates reflecting a delayed-type of hypersensitivity reaction to the spirochete.

Primary syphilis

  • Mononuclear leukocytic infiltration, macrophages, and lymphocytes
  • Swelling and proliferation of small blood vessels

Secondary syphilis

  • Swelling and dilatation of blood vessels in the dermis
  • Epidermal hyperplasia and neutrophilic infiltration
  • Inflammatory cell infiltrate, predominantly plasma cell

Tertiary syphilis

  • A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests.
Darkfield examinations and tests to detect T. pallidum.
Brucellosis humans could be infected by eating undercook meat or raw dairy products, inhalation of the bacteria and direct contact of bacteria with skin wounds or mucous membranes. Following transmission, white blood cells phagocyte the pathogen and transports it via hematologic or lymphatic route to different organs specially to those of the reticuloendothelial system.
  • Fever
  • Rash
  • Abdominal pain
  • weightloss
  • Painful lymphadenopathy
  • hepatosplenomegaly
  • arthritis
  • Brucella is most commonly isolated from blood cultures (blood cultures are positive between the 7th and 21st day)
Viral infectious mononucleosis
  • Epstein-Barr virus, frequently referred to as EBV,
  • the virus infects B cells located in the oropharyngeal epithelium and subsequently spreads to involve the lymph nodes, liver and spleen.
  • incubation period ranges from 4 to 6 weeks.
Characteristic triad of fever, pharyngitis, and lymphadenopathy lasting for 1 to 4 weeks.

Common symptoms include low-grade fever without chills, sore throat, white patches on tonsils and back of the throat, muscle weakness and sometime extreme fatigue, tender lymphadenopathy, petechial hemorrhage and skin rash.

Peripheral Blood Smear

  • hallmark of the disease is the presence of atypical lymphocytes (a type of mononuclear cell) .
  • Atypical lymphocytosis is present in approximately 75% of patients
  • Greater than 10% atypical lymphocytes is diagnostic of mononucleosis.
cytomegalovirus Common symptoms include sore throat, swollen lymph nodes, fever, headache, fatigue, weakness, muscle pain and loss of appetite.
  • Positive monospot test.
  • Elevated liver enzymes
  • PCR of CSF with detectable virus is diagnostic.
  • CT/MRI/biopsy: location of lesions are usually near the brain stem or periventricular areas.
  • Brain biopsy with + staining for CMV or evidence of owl's eyes is also diagnostic.
human immunodeficiency virus Acute HIV infection may be asymptomatic or may cause a mononucleosis-like syndrome fever, fatigue, sore throat, myalgia, and lymphadenopathy
cat scratch fever The causative organism was first thought to be Afipia felis, but this was disproved by immunological studies demonstrating that cat scratch fever patients developed antibodies to two other organisms, Bartonella henselae (B. henselae) and Bartonella clarridgeiae, which are rod-shaped Gram-negative bacteria. Symptoms of Cat scratch fever are:
  • Polymerase chain reaction (PCR) is the most sensitive test and is able to differentiate between different Bartonella species.
  • Serological testing (indirect immunofluorescence or enzymatic immunoassay with titration of IgG or IgM antibodies) - to detect serum antibody to B henselae.
Mycobacterial tuberculosis
  • Mostly in endemic areas
Symptoms include productive cough,night sweats, fever and weight loss, hemoptysis
  • Sputum smear positive for acid-fast bacilliand nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
Mild normocytic anemia, hyponatremia, and

hypercalcemia

  • CXR and CT demonstrates cavities in the upper lobe of the lung
Parasitic toxoplasmosis A parasitic disease caused by ingestion of cat feces, affect all organs and particularly dangerous in pregnant woman. Toxoplasma infections may also present with a mononucleosis-like syndrome seen in patients with acute HIV syndrome.
Autoimmune Systemic lupus erythematosus skin rash, arthritis, positive autoimmune serology, weight loss, feversand chronic pain, ESR and CRPelevated, positive ANA
Sjögren's syndrome skin rash, arthritis, positive autoimmune serology, weight loss, feversand chronic pain,
Hydantoin derivatives
Sarcoidosis
  • serum ACE level
  • On CXR bilateral adenopathy and coarse reticular opacities are seen.
  • CT of the chest demonstrates extensive hilar and mediastinal adenopathy
  • Additional findings on CT include fibrosis (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.
  • Biopsy of lung shows non-caseatinggranuloma
Neoplasms Hodgkin's disease Reed-Sternberg cell
  • B-cell origin
  • CD30 (Ki-1) and CD15 (Leu-M1) antigens
  • Painless localized peripheral lymphadenopathy
  • B symptoms
  • Lactate dehydrogenase (LDH) may be increased.
  • ESR elevated
  • Serum creatinine elevated in nephrotic syndrome.
  • Alkaline phosphatase (ALP) increased
  • Hypercalcemia, hypernatremia, and hypoglycemia.

Fine-needle aspiration

  • Mononucleate and binucleate Reed-Sternberg cells in a background of inflammatory cells
Chronic lymphocytic leukemia
  • Clonal B cells arrested in the B-cell differentiation pathway,.
  • Genetic mutations that promote both malignantleukemic proliferation and apoptotic resistance of mature B cells.
  • Structural genetic mutations involved in the pathogenesis of chronic lymphocytic leukemia include chromosome 13q deletion, chromosome 17p deletion, and chromosome 11q deletion.
  • Monoclonality of kappa and lambda producing B cells
  • Presence of smudge cells
CBC
Small cell carcinoma of the lung relatively rapid onset of symptoms and is associated with the occurrence of paraneoplastic syndromes such as the syndrome of inappropriate antidiuresis (SIADH), hypercalcemia and many more. Nearly all SCLC are immunoreactive for

Neuroendocrine and neural differentiation result in the expression of molecules like

The confirmation of the diagnosis of SCLC is by tumor biopsy.

patients with confirmed diagnosis of SCLC should undergo a CT scan of the abdomen for staging purposes.

CT scan of the abdomen helps identify metastasis to organs, such as the liver or the adrenal glands.

Malignant histiocytosis
Melanoma
  • melanoma is the result of multiple genetic mutations. The progression to melanoma usually involves the serine-threonine kinases of the MAPK/ERK pathway (mitogen-activated protein kinase) following mutation of either the N-RAS or BRAF oncogene
  • changes include the overexpression of N-cadherin, αVβ3 integrin, MMP-2, MSH, cAMP, and survivin, and the loss of E-cadherin and TRMP1 proteins
Symptoms of melanoma include the following: An excisional biopsy (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins is diagnostic.
Germ cell neoplasms
Other conditions Reactive lymphoid hyperplasia
Lymphomatoid granulomatosis Lymphamatoid granulomatosis manifests in a variety of clinical forms. CBC The following x-ray findings are suggestive of assisting in diagnosing Lymphmotoid granulomatosis:
Dermatopathic lymphadenopathy
Angioimmunoblastic lymphadenopathy Symptoms include:
  • Immunophenotyping
  • Fluorescence in situ hybridization (FISH)
Lymph node or extranodal tissue biopsy is diagnostic of angioimmunoblastic T-cell lymphoma.

CT scan suggestive of angioimmunoblastic T-cell lymphoma include:

Giant lymph node hyperplasia (Castleman disease) Castleman's disease is likely due to hypersecretion of the cytokine IL-6. In KSHV positive tumors, this is most likely due to expression of the a virus-encoded cytokine, vIL-6, while KSHV negative tumors appear to be the result of over secretion of human IL-6. The most common 'B symptoms' of MCD are

Other symptoms include: