21-years old male with 1 week of low-grade fever (up to 37,6 | Figure 1
Case Report
Patient Presentation
21-years old male with 1 week of low-grade fever (up to 37,6°C), malaise, mild sore throat, dry cough, painful lymph nodes of neck and bilateral hip pain. During last two weeks he lost 6 kg. He didn't have night sweats. Last few days have "hissing in the lungs".
Physical Examination
Physical exam showed one enlarged lymph node in each axilla (~2 cm, movable, painless), slight pharyngeal hyperemia, more highly pitched bronchial sound in right middle lung field paravertebrally, slight tenderness in right paraumbilical area of abdomen. The rest of exam was normal.
Laboratory Findings
Laboratory analyses showed only elevated CK (384) and slightly lower AP (42). CBC and rest of the biochemistry was normal.
Ultrasound of axillae showed one enlarged (~2 cm) reactive lymph node in each axilla. The lymph nodes in neck area were normal.
Abdominal X-ray and ultrasound of abdomen were normal.
Chest X-ray showed left (para-)hilar mass 40 x 50 mm in size, for which the radiologist noted that could be an enlarged lymph node (but he wasn't sure).
Differential Diagnosis
I have ideas that this could be lymphoma, sarcoidosis, atypical Löfgren syndrome (no erythema nodosum), other neoplasms. TB for me is less likely because of quick course.
Discussion
What is your opinion?