Differential Diagnosis for a 29-year-old Male with Prolonged Fever and Leukopenia
Single Most Likely Diagnosis
- Viral infections (e.g., HIV, EBV, CMV): These infections can cause prolonged fever and leukopenia. The patient's negative tests for common infections like malaria, dengue, and normal chest X-ray suggest a viral etiology.
Other Likely Diagnoses
- Tuberculosis (TB): Although the chest X-ray is normal, TB can present with extrapulmonary symptoms, including fever and leukopenia. A high index of suspicion is required, especially in endemic areas.
- Brucellosis: This zoonotic infection can cause fever, leukopenia, and is often associated with occupational exposure to animals.
- Endocarditis: Although less common in young adults without a history of heart disease, endocarditis can present with fever and leukopenia, especially if the infection is caused by a HACEK organism.
Do Not Miss Diagnoses
- HIV/AIDS: A diagnosis of HIV/AIDS is crucial, as it can present with prolonged fever and leukopenia. Missing this diagnosis can have significant consequences for the patient's treatment and prognosis.
- Sepsis: Although the patient's WBC count is low, sepsis can present with leukopenia, especially in the early stages. It is essential to consider sepsis, as it requires prompt treatment.
- Lymphoma/Leukemia: These malignancies can cause fever and leukopenia. Although less common, they are critical to diagnose, as treatment options are available.
Rare Diagnoses
- Applastic anemia: A rare condition characterized by bone marrow failure, which can present with leukopenia and fever.
- Felty's syndrome: A rare condition associated with rheumatoid arthritis, characterized by fever, leukopenia, and splenomegaly.
- Cyclic neutropenia: A rare condition characterized by periodic episodes of neutropenia, which can present with fever and leukopenia.