Differential Diagnosis for a Patient with Chronic Myelomonocytic Leukemia (CMML) and Possible Sepsis
Single Most Likely Diagnosis
- Sepsis due to bacterial infection: This is the most likely diagnosis given the patient's immunocompromised state due to CMML, which increases the risk of infections. Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.
Other Likely Diagnoses
- Neutropenic fever: Patients with CMML often have neutropenia, making them susceptible to fever of unknown origin, which could be due to various infections or other causes.
- Leukemic transformation or progression: CMML can progress or transform into acute myeloid leukemia (AML), which might present with symptoms similar to sepsis, such as fever and deterioration of performance status.
- Infection-related complications: Given the patient's compromised immune system, infections such as pneumonia, urinary tract infections, or skin infections could be present and might not always present with typical symptoms.
Do Not Miss Diagnoses
- Tumor lysis syndrome: Although less common in CMML compared to other leukemias, tumor lysis syndrome is a potentially life-threatening condition that can occur spontaneously or after treatment initiation.
- Disseminated intravascular coagulation (DIC): This is a serious disorder in which the proteins responsible for blood clotting become overactive, leading to the formation of small blood clots in various blood vessels throughout the body. It can be a complication of sepsis or leukemia.
- Invasive fungal infections: Patients with CMML, especially those with prolonged neutropenia, are at increased risk for invasive fungal infections, which can be difficult to diagnose and treat.
Rare Diagnoses
- Hemophagocytic lymphohistiocytosis (HLH): A rare disorder of the immune system where it produces too many activated immune cells called macrophages and lymphocytes. These cells infiltrate various tissues and can cause organ damage.
- Leukoagglutination or leukostasis: Although more commonly associated with very high white blood cell counts typically seen in other types of leukemia, these conditions can lead to respiratory and neurological distress due to sludging of leukemic cells in small blood vessels.