Differential Diagnosis for Hypoalbuminemia, Anemia with Leukocytosis, Elevated Bilirubins, No Splenomegaly, with Fatty Liver

• Single Most Likely Diagnosis
  • NASH (Non-Alcoholic Steatohepatitis): This condition is characterized by fatty liver, which is indicated in the scenario. NASH can lead to hypoalbuminemia due to impaired liver function, anemia from chronic disease, and elevated bilirubins due to liver dysfunction. Leukocytosis can occur in response to inflammation. The absence of splenomegaly does not rule out NASH, as it is more commonly associated with liver pathology rather than spleen enlargement.
• Other Likely Diagnoses
  • Alcoholic Liver Disease: Although the question does not specify alcohol use, alcoholic liver disease can present with similar laboratory findings, including hypoalbuminemia, anemia, leukocytosis, and elevated bilirubins. Fatty liver is a hallmark of early alcoholic liver disease.
  • Chronic Viral Hepatitis: Conditions like hepatitis B and C can lead to chronic liver inflammation, resulting in hypoalbuminemia, anemia, and elevated bilirubins. Leukocytosis may be present due to the body's immune response to the virus. Fatty liver can also be seen in chronic hepatitis.
• Do Not Miss Diagnoses
  • Severe Sepsis: Although less likely given the specific combination of findings, severe sepsis can cause hypoalbuminemia, anemia, leukocytosis, and elevated bilirubins due to multi-organ dysfunction, including liver impairment. The absence of splenomegaly does not rule out sepsis. Missing this diagnosis could be fatal.
  • Hemophagocytic Lymphohistiocytosis (HLH): This rare but life-threatening condition can present with similar laboratory abnormalities, including anemia, leukocytosis, and elevated bilirubins. Although splenomegaly is often present in HLH, its absence does not exclude the diagnosis.
• Rare Diagnoses
  • Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver dysfunction, fatty liver, anemia, and elevated bilirubins. However, it typically presents at a younger age and may include neurological symptoms.
  • Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease, including fatty liver, and may lead to the laboratory findings described. It is less common and often presents in childhood, but adult-onset cases can occur.