Differential Diagnosis for Sepsis of Unknown Origin
The patient presents with an increasing temperature to 38 degrees and elevated white cell and neutrophil counts, indicating a potential septic process. The following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Pneumonia: This is a common cause of sepsis, especially in patients with respiratory symptoms or those who are elderly or immunocompromised. The diagnosis can be confirmed with chest imaging and blood cultures.
- Other Likely Diagnoses
- Urinary Tract Infection (UTI): UTIs are a frequent cause of sepsis, particularly in patients with urinary catheters or those who are elderly. Diagnosis can be made with urinalysis and urine culture.
- Intra-abdominal Infection: Conditions such as cholecystitis, appendicitis, or diverticulitis can lead to sepsis. Imaging studies like CT scans can help identify the source.
- Skin and Soft Tissue Infections: Severe infections like cellulitis or necrotizing fasciitis can cause sepsis. Clinical examination and imaging can aid in diagnosis.
- Do Not Miss Diagnoses
- Meningitis: Although less common, meningitis is a life-threatening condition that requires prompt diagnosis and treatment. Symptoms like headache, stiff neck, and altered mental status should raise suspicion.
- Endocarditis: Infective endocarditis can present with non-specific symptoms and is a critical diagnosis to consider, especially in patients with a history of heart disease or intravenous drug use.
- Necrotizing Fasciitis: This is a rapidly progressing infection that can be fatal if not recognized and treated promptly. Patients may present with severe pain, swelling, and skin changes.
- Rare Diagnoses
- Lemierre's Syndrome: A rare condition characterized by sepsis and thrombophlebitis of the internal jugular vein, often associated with Fusobacterium necrophorum infection.
- Toxic Shock Syndrome: A life-threatening condition caused by bacterial toxins, typically associated with Staphylococcus aureus or Streptococcus pyogenes infections.
- Candidemia: A fungal infection that can cause sepsis, particularly in immunocompromised patients or those with central venous catheters.