Lymphadenopathies: in the labyrinth of differential diagnosis

DOI: https://doi.org/10.29296/25877305-2023-05-06
Issue: 
5
Year: 
2023

Associate Professor Z. Mikhailova, MD; А. Saidov
City Clinical Hospital Thirty-Eight, Nizhny Novgorod

When supervising patients, a practicing physician daily faces various clinical and laboratory syndromes. To make a differential diagnosis for many conditions and diseases, the physician must have not only practical experience, but also a broad outlook, including in a number of related specialties. The pathomorphism of diseases, the atypical clinical presentation at the onset of the disease increasingly require the involvement of a multidisciplinary team to solve diagnostic puzzles. The presented clinical case considers the stages of inpatient diagnostic search in a patient with generalized lymphadenopathy. Exclusion of lymphoproliferative diseases became possible only after lymph node excision biopsy, by making an immunohistochemical study, bone marrow puncture, and trepanobiopsy. The nephrotic syndrome and the thyrotoxicosis syndrome have become the following stage of a differential diagnosis.

Keywords: 
lymphadenopathy
nephrotic syndrome
systemic lupus erythematosus.



References: 
  1. Богданов А.Н., Волошин С.В., Кулибаба Т.Г. и др. Изменения системы крови в клинической практике. СПб: Фолиант, 2017; 172 с. [Bogdanov A.N., Voloshin S.V., Kulibaba T.G. et al, Changes in the blood system in clinical practice. St. Petersburg: Foliant, 2017; 172 p. (in Russ.)].
  2. Национальные клинические рекомендации по диагностике лимфаденопатий, 2018; 30 с. [National clinical guidelines for the diagnosis of lymphadenopathy, 2018; 30 p. (in Russ.)].
  3. Клиническая онкогематология: руководство для врачей. Под ред. М.А. Волковой. 2-е изд., перераб. и доп. М.: Медицина, 2007; 1120 с. [Clinical oncohematology: a guide for doctors. Ed. M.A. Volkova. 2nd ed., revised. and additional. M.: Meditsina, 2007; 1120 р. (in Russ.)].
  4. Захарова Е.В., Столяревич Е.С. Особенности нефропатий при лимфопролиферативных и плазмоклеточных заболеваниях (опыт одного центра). Альманах клинической медицины. 2014; 30: 3–11 [Zakharova E.V., Stolyarevich E.S. Kidney damage in lymphoproliferative and plasma cell disorders (one center experience). Almanac of Clinical Medicine. 2014; 30: 3-11. (in Russ.)]. DOI: 10.18786/2072-0505-2014-30-3-11
  5. Кардиология: национальное руководство. Под ред. Е.В. Шляхто. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2021; 800 с. [Cardiology: national leadership. Ed. E.V. Shlyakhto. 2nd ed., revised. and additional. M.: GEOTAR-Media, 2021; 800 p. (in Russ.)].
  6. Терновой С.К. Томография сердца. М.: ГЭОТАР-Медиа, 2018; 296 с. [Ternovoy S.K. Cardiac tomography. M.: GEOTAR-Media, 2018; 296 p. (in Russ.)].
  7. Ревматология. Российские клинические рекомендации. Под ред. Е.Л. Насонова. М.: ГЭОТАР-Медиа, 2020; 448 с. [Rheumatology. Russian clinical guidelines. Ed. E.L. Nasonov. M.: GEOTAR-Media, 2020; 448 p. (in Russ.)].
  8. Fanouriakis A., Kostopoulou M., Alunno A. et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019; 78 (6): 736–45. DOI: 10.1136/annrheumdis-2019-215089
  9. Попкова Т.В., Панафидина Т.А., Соловьев С.К. По материалам обновленных рекомендаций Европейской антиревматической лиги (EULAR) по лечению системной красной волчанки – 2019: дискуссионные вопросы и комментарии. Научно-практическая ревматология. 2019; 57 (5): 496–510 [Popkova T.V., Panafidina T.A., Solovyev S.K. According to the 2019 updated European League Against Rheumatism (EULAR) recommendations for the treatment of systemic lupus erythematosus: debatable issues and comments. Rheumatology Science and Practice. 2019; 57 (5): 496–510 (in Russ.)]. DOI: 10.14412/1995-4484-2019-496-510
  10. Клинические рекомендации. Диагностика и лечение волчаночного нефрита. 2021; 70 с. [Clinical guidelines. Diagnosis and treatment of lupus nephritis. 2021; 70 p. (in Russ.)].
  11. Yafasova A., Fosbøl E.L., Schou M. et al. Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus. J Am Coll Cardiol. 2021; 77 (14): 1717–27. DOI: 10.1016/j.jacc.2021.02.029
  12. Лисицына Т.А., Вельтищев Д.Ю., Серавина О.Ф. и др. Рекомендации по диагностике и лечению психических расстройств при ревматических заболеваниях. 2016; 23 с. [Lisitsyna T.A., Veltishchev D.Yu., Seravina O.F. e al. Recommendations for the diagnosis and treatment of mental disorders in rheumatic diseases. 2016; 23 p. (in Russ.)].