Facial Nodules (excluding those in the parotid)

CLINICAL DIAGNOSIS MANUAL

The following table summarises key information about various pathologies that may present as facial nodules, excluding those in the parotid. It details the typical symptoms and clinical signs, as well as the diagnostic tests needed for both initial suspicion and confirmation of the diagnosis.

Pathology	Symptoms and Clinical Signs	Diagnosis of Suspicion	Diagnosis of Confirmation
Viral Infections (influenza, COVID-19, dengue, mononucleosis)	Fever, headache, myalgia, fatigue, cough, sore throat, nasal congestion (in influenza and COVID-19), skin rashes (in dengue), lymphadenopathy (in mononucleosis).	History of recent exposure to viral infections or respiratory symptoms.	Serological tests or PCR for virus detection (influenza, SARS-CoV-2, dengue), antigen test, throat swab.
Bacterial Infections (pneumonia, pyelonephritis, meningitis, bacterial endocarditis)	High fever, chills, diaphoresis, chest pain (in pneumonia), back pain (in pyelonephritis), neck stiffness and headache (in meningitis), heart murmur (in endocarditis).	History of high fever associated with localised symptoms (respiratory, urinary, meningeal).	Blood culture, urine analysis, chest X-ray (for pneumonia), lumbar puncture (for meningitis), echocardiogram (for endocarditis).
Parasitic Infections (malaria, leishmaniasis, toxoplasmosis)	Intermittent fever, chills, sweating, abdominal pain (malaria), skin lesions and visceromegaly (leishmaniasis), neurological or ocular symptoms (toxoplasmosis).	History of travel to endemic areas or exposure to parasites.	Blood smear to identify parasites (malaria), skin or visceral biopsy (leishmaniasis), serology or PCR (toxoplasmosis).
Fungal Infections (histoplasmosis, disseminated candidiasis)	Fever, chronic cough, weight loss (in histoplasmosis), skin or visceral lesions, persistent fever despite antibiotic treatment (in disseminated candidiasis).	History of immunosuppression or exposure to endemic fungal areas.	Sputum or blood culture, biopsy of affected tissue, serology for fungal antigens, imaging tests (chest X-ray or CT in histoplasmosis).
Autoimmune Disorders (systemic lupus erythematosus, rheumatoid arthritis)	Persistent low-grade fever, fatigue, skin rashes (in lupus), joint pain, morning stiffness (in rheumatoid arthritis), renal or pulmonary lesions (in lupus).	History of chronic fever associated with autoimmune symptoms.	Positive ANA, double-stranded DNA (in lupus), rheumatoid factor or anti-CCP antibodies (in rheumatoid arthritis), biopsy of affected organs (skin, kidney).
Malignant Neoplasms (leukaemia, lymphoma)	Persistent fever, weight loss, night sweats, fatigue, generalised lymphadenopathy, hepatosplenomegaly.	History of prolonged fever, unexplained weight loss, lymphadenopathy.	Complete blood count showing leukocytosis or cytopenias, bone marrow biopsy, imaging studies (CT, PET) to assess lymphadenopathy or organ infiltration.
Fever of Unknown Origin	Prolonged fever (>3 weeks), with no apparent cause after initial studies, fatigue, weight loss.	History of prolonged fever with no apparent cause.	Extensive studies including repeated blood cultures, serological tests, tissue biopsies, CT or MRI imaging, depending on associated symptoms.
Drug Reaction (hypersensitivity syndrome)	Fever, skin rashes, lymphadenopathy, eosinophilia, hepatic or renal involvement, respiratory symptoms.	History of recent use of new medications (anticonvulsants, antibiotics).	Complete blood count with eosinophilia, abnormal liver and kidney tests, withdrawal of suspected drug and clinical improvement, skin biopsy if necessary.
Inflammatory Diseases (ulcerative colitis, Crohn’s disease)	Intermittent fever, diarrhoea with or without blood, abdominal pain, weight loss, general malaise.	History of chronic digestive symptoms associated with fever.	Colonoscopy with biopsy showing chronic inflammation, imaging studies (abdominal CT), elevated inflammatory markers (CRP, ESR), specific antibodies (pANCA for ulcerative colitis).