Differential Diagnosis for 91 year-old female with baseline emphysema
- Single most likely diagnosis
- Chronic steroid-induced leukocytosis: The patient is on daily steroids, which can cause an increase in white blood cell count. Given the patient's long-term steroid use and the absence of other clear infectious sources, this is a plausible explanation for the elevated white count.
- Other Likely diagnoses
- Chronic bronchitis or exacerbation of emphysema: The patient's underlying lung disease could be contributing to the elevated white count, especially if there is an exacerbation or a chronic infection.
- Colonization or infection with a resistant organism: The patient's elevated white count despite negative chest X-ray could indicate a localized infection, such as a urinary tract infection or a skin infection, that is not immediately apparent.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient does not have a clear source of infection, sepsis can present subtly in elderly patients and is a life-threatening condition that requires prompt recognition and treatment.
- Pulmonary embolism: The patient's underlying emphysema and oxygen requirement increase her risk for pulmonary embolism, which can be difficult to diagnose and would be catastrophic if missed.
- Invasive aspergillosis: The patient's long-term steroid use and underlying lung disease put her at risk for invasive aspergillosis, a potentially deadly fungal infection.
- Rare diagnoses
- Leukemoid reaction: A rare condition characterized by a marked increase in white blood cell count, often in response to severe infection, inflammation, or other stressors.
- Lymphoproliferative disorder: A rare condition that can cause an elevated white count, although this would be unusual in the context of the patient's presentation.