Differential Diagnosis
The patient's presentation of persistent bruising, particularly around the eyes, along with a palpable abdominal mass and recent weight loss, suggests a serious underlying condition. The following differential diagnoses are considered:
Single most likely diagnosis
- D. Neuroblastoma: The presence of infraorbital ecchymoses (periorbital bruising) and a palpable abdominal mass is highly suggestive of neuroblastoma, a common extracranial solid tumor in children. The rapid, jerking movements of the eyes (opsoclonus) can also be associated with neuroblastoma, particularly in the context of an abdominal mass.
Other Likely diagnoses
- C. Leukemia: Although less likely than neuroblastoma given the specific combination of symptoms, leukemia could explain the bruising and weight loss. However, the presence of a distinct abdominal mass and opsoclonus is more characteristic of neuroblastoma.
- F. Wilms tumor: This is another abdominal tumor that could present with a palpable mass. However, Wilms tumor typically does not cause periorbital bruising or opsoclonus.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- A. Child abuse: Given the history of the parents being divorced and the child spending weekends with the father, child abuse must be considered, especially with unexplained bruising. However, the specific pattern of bruising and the presence of an abdominal mass and opsoclonus make this less likely.
- B. Immune thrombocytopenia: This condition could cause bruising due to low platelet counts, but it would not explain the abdominal mass or opsoclonus.
Rare diagnoses
- E. Von Willebrand disease: A bleeding disorder that could potentially cause bruising, but it would not account for the abdominal mass or the specific eye movements.
- Other rare conditions, such as metastatic disease from another primary site or unusual infections, are less likely given the clinical presentation but should be considered if initial diagnoses are ruled out.