What is the diagnosis for a 3-month-old boy presenting with fever, respiratory distress, cough, and labored breathing, with computed tomography (CT) scan revealing diffuse micronodular lesions in the lungs, liver, and spleen, and hepatosplenomegaly?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: May 5, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis for a 3-month-old Boy with Fever, Respiratory Distress, and Diffuse Micronodular Lesions

  • Single Most Likely Diagnosis
    • Disseminated Histoplasmosis: This diagnosis is likely due to the patient's symptoms, including fever, respiratory distress, and diffuse micronodular lesions in the lungs, liver, and spleen. The patient's residence in North Carolina, an area endemic for histoplasmosis, and exposure to dogs and a cat, which can carry the fungus, further support this diagnosis.
  • Other Likely Diagnoses
    • Disseminated Coccidioidomycosis: Although less common in North Carolina, this fungal infection can cause similar symptoms and should be considered, especially if the patient has traveled to endemic areas.
    • Lymphoma or Leukemia: The presence of hepatosplenomegaly and diffuse micronodular lesions could suggest a hematologic malignancy, which would require further evaluation.
    • Tuberculosis: The grandmother's chronic cough raises the possibility of tuberculosis, which can cause similar symptoms and should be investigated, especially if the patient has been in close contact with her.
  • Do Not Miss Diagnoses
    • Congenital Infections (e.g., Toxoplasmosis, Cytomegalovirus): These infections can cause severe illness in infants and may present with similar symptoms, including hepatosplenomegaly and respiratory distress.
    • Bacterial Sepsis or Meningitis: These conditions can cause rapid deterioration and require prompt recognition and treatment.
    • Inborn Errors of Metabolism: Certain metabolic disorders can cause liver and spleen enlargement, as well as respiratory distress, and may be life-threatening if not recognized and treated promptly.
  • Rare Diagnoses
    • Langerhans Cell Histiocytosis: This rare disorder can cause multisystem involvement, including lung, liver, and spleen lesions, but is less likely given the patient's age and presentation.
    • Chronic Granulomatous Disease: This immunodeficiency disorder can cause recurrent infections and granulomatous disease, but is rare and would require further evaluation to confirm.

Related Questions

What is Schnitzler Syndrome?
Is excessive protein intake harmful?
Can initiating beta blockers (beta-adrenergic blocking agents) be harmful to a patient with new myocarditis?
What does an elevated count of Polymorphonuclear (PMNs) leukocytes indicate?
When should you initiate an Angiotensin-Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) in patients with new decompensated heart failure?
When to hold Jardiance (Empagliflozin) before surgery?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question