Thoughts on lymphadenopathy, splenomegaly, sense of nausea and swelling in left armpit?

Hi,

I'm medical student. I'm 21 now. About 3 months ago I accidentally realized that there are several enlarged lymph nodes in my neck! There was no pain and tenderness at the beginning!

  • In sonography there are 38 lymphadenopathy in my parotid, mandibular angle, posterior cervical chain on both sides of my neck and they are symmetrical.
  • I have no pain and tenderness, solid and fluctuable and splenomegaly (spleen size: 135. 85) and one lymphadenopathy in left axilla!
  • In CBC wbc is normal
  • PT is low about 145000
  • MCH is low
  • CXR is also normal
  • EBV test(mono test) is negative

There are no other symptoms, just a sense of nausea and mild swelling in my left armpit which have appeared recently! I was told that a biopsy is necessary but before the biopsy I was tested for toxoplasmosis for caution!

  • I don't have a cat
  • I never eat vegetables and fruits without completely washing them. I have no contact with soil - nothing!
  • I have had no suspicious contact.
  • I just had a cat about 5 years ago just for a short time (2 or 3 months).
  • Unfortunately my toxo test is positive: IgM is about 2 and IgG is 200!

Now my questions are:

  1. Does positive toxoplasmosis test rule out other differential diagnosis like lymphoma? ( I have read that clinical manifestations of toxoplasmosis are rare and occur in children who have cat. and most cases have high IgM about 11or 12 in children and in some references about 20 or 43 in adults not a low positive like2!)
  2. Is my lymphadenopathy because of a low positive like2?
  3. Is biopsy still necessary?

Your help will be greatly appreciated!

Thank you!

Authored By baran on Monday 17th December 2012