A 40-year-old patient presents with fever, night sweats, and a 3 cm, non-tender lymph node in the neck. Chest X-ray shows mediastinal adenopathy. The most likely diagnosis is

• A. Hodgkin's disease
• B. Chronic lymphocytic leukemia
• C. Hairy cell leukemia
• D. Multiple myeloma

Answer: (A)

Fever and night sweats with a painless, enlarging cervical lymph node and mediastinal adenopathy on imaging point strongly to Hodgkin lymphoma. This disease classically presents in young to middle-aged adults as painless lymphadenopathy, often in the neck, and frequently involves the mediastinum. Constitutional symptoms, known as B symptoms (fever, drenching night sweats, weight loss), may accompany the nodal involvement, reflecting systemic disease. The underlying cells are Reed-Sternberg cells, which are malignant B cells that help drive this pattern of presentation.

This distinguishes it from other entities. Chronic lymphocytic leukemia tends to affect older individuals and presents with generalized lymphadenopathy and often cytopenias rather than a localized neck node with mediastinal mass. Hairy cell leukemia usually features splenomegaly and cytopenias rather than prominent lymph node enlargement. Multiple myeloma presents with bone pain, hypercalcemia, anemia, and renal problems, with lytic bone lesions rather than a pattern centered on lymphadenopathy and mediastinal involvement.