Differential Diagnosis for Chronic Fever in a Child with Lymphadenopathy and Hepatosplenomegaly
Single Most Likely Diagnosis
- Infectious Mononucleosis (Mono): Caused by Epstein-Barr virus (EBV), this condition is common in children and often presents with fever, lymphadenopathy, and hepatosplenomegaly. The clinical presentation and age of the patient make this a highly probable diagnosis.
Other Likely Diagnoses
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can present with lymphadenopathy, hepatosplenomegaly, and systemic symptoms like fever. Given the combination of symptoms, lymphoma is a plausible consideration.
- Tuberculosis (TB): TB can cause chronic fever, lymphadenopathy, and hepatosplenomegaly, especially in endemic areas or in individuals with compromised immune systems. The diagnosis should be considered based on exposure history and epidemiological context.
- Juvenile Idiopathic Arthritis (JIA): Systemic JIA can present with fever, lymphadenopathy, hepatosplenomegaly, and rash, making it another potential diagnosis in this clinical scenario.
Do Not Miss Diagnoses
- Leukemia: Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) can present with nonspecific symptoms including fever, lymphadenopathy, and hepatosplenomegaly. Given the potential for rapid progression and the importance of early treatment, leukemia must be considered and ruled out promptly.
- HIV Infection: Children with HIV can present with chronic fever, lymphadenopathy, and hepatosplenomegaly due to the infection itself or due to opportunistic infections. The diagnosis of HIV is critical for the management and prognosis of the patient.
- Kawasaki Disease: Although more commonly associated with specific clinical criteria (fever, rash, mucous membrane changes, extremity changes, and cervical lymphadenopathy), Kawasaki disease can sometimes present atypically and must be considered to avoid missing this potentially serious condition that requires prompt treatment.
Rare Diagnoses
- Langerhans Cell Histiocytosis (LCH): A rare disorder that can cause a variety of systemic symptoms including fever, lymphadenopathy, and hepatosplenomegaly, along with specific organ involvement like the bones or skin.
- Castleman Disease: A rare lymphoproliferative disorder that can present with lymphadenopathy, fever, and systemic symptoms, including hepatosplenomegaly.
- Autoimmune Lymphoproliferative Syndrome (ALPS): A rare genetic disorder characterized by lymphadenopathy, hepatosplenomegaly, and autoimmune cytopenias, which could be considered in the differential diagnosis of a child with chronic fever and lymphoproliferation.