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Aktuelle Rheumatologie 2024; 49(04): 229-239
DOI: 10.1055/a-2311-7870
Originalarbeit

Differenzialdiagnostik von benignen Lymphadenopathien in der Rheumatologie

Differential Diagnosis of Benign Lymphadenopathies in Rheumatology
Leonore Unger
1   1. Medizinische Klinik Städtisches Klinikum Dresden  Friedrichstadt, Dresden, Germany
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Zusammenfassung

Lymphadenopathien sind im praktischen Alltag häufig und für Rheumatologen von hoher klinischer Relevanz. Viele Autoimmunkrankheiten einschließlich der Rheumatoiden Arthritis, des Systemischen Lupus erythematodes und des Sjögren-Syndroms können damit einhergehen. Zur Abgrenzung von Malignomen, insbesondere von Lymphomen und Infektionen sind eine ausführliche Anamnese, die Beachtung von Warnzeichen (red flags) und eine gründliche Diagnostik erforderlich. Das gleichzeitige Vorliegen von Autoimmunerkrankungen und Infektionen oder auch Autoimmunität und Malignomen kann dabei eine Herausforderung sein. Neben der klinischen Untersuchung nimmt die Lymphknotensonographie in der Diagnostik einen hohen Stellenwert ein. Besondere Bedeutung hat die histologische Beurteilung, die vom vollständig entnommenen Lymphknoten erfolgen sollte. Für die infektiösen Erkrankungen ist der Erreger- und Antikörpernachweis von Bedeutung. Extranodale Manifestationen werden mittels Sonographie, CT- und MRT- Diagnostik oder auch PET-CT erfasst. In dieser Übersichtsarbeit werden die benignen Differenzialdiagnosen von Lymphadenopathien dargestellt. Dabei wird auch auf seltene Erkrankungen wie den M. Whipple, die IgG4-assoziierten Erkrankungen, den M. Castleman und andere eingegangen.

Abstract

Lymphadenopathy is frequently encountered in medical practice and is of high clinical relevance for rheumatologists. Lymphadenopathy may be accompanied by a number of autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus, and Sjögren’s syndrome. To differentiate lymphadenopathy from malignant diseases, especially from lymphoma, or infections, clinicians must record the patient’s medical history in detail, look out for warning signs or red flags, and perform a thorough diagnostic work-up. The simultaneous presence of autoimmune diseases and infections or even autoimmunity and malignancy can be a challenge. In addition to a clinical examination, ultrasound imaging of the lymph nodes is a crucial element of the diagnostic investigation. A histological examination is especially important; the histology sample should be taken from a fully resected lymph node. In cases of infectious disease, it is important to detect the pathogen and antibodies. Extranodal manifestations are visualised by means of ultrasound, CT, MRI, or a PET scan. In this overview, we present the benign differential diagnoses of lymphadenopathy. We also address rare conditions such as Whipple’s disease, IgG4-related disease, Castleman’s disease, and others.

Schlüsselwörter

Lymphadenopathien - Infektionen - Autoimmunopathien - IgG4-assoziierte Erkrankungen - M.Castleman

Keywords

infections - autoimmunopathies - IgG4-related diseases - Castleman's disease - lymphadenopathy


Publication History

Article published online:
24 July 2024

© 2024. Thieme. All rights reserved.

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