Differential Diagnosis for a 7-year-old child with chronic fever, hepatosplenomegaly, lymphadenopathy, and elevated inflammatory markers
- Single most likely diagnosis:
- Tuberculosis (TB): Despite the CBNAAT being negative for AFB, TB remains a strong consideration due to the clinical presentation of chronic fever, hepatosplenomegaly, and lymphadenopathy. TB can have a variable presentation, and a negative CBNAAT does not entirely rule out the disease, especially in pediatric cases where the sensitivity of the test might be lower.
- Other Likely diagnoses:
- Autoimmune Lymphoproliferative Syndrome (ALPS): This condition is characterized by chronic lymphadenopathy, hepatosplenomegaly, and elevated inflammatory markers, which aligns with the child's presentation.
- Juvenile Idiopathic Arthritis (JIA) - Systemic form: Although more commonly associated with joint symptoms, the systemic form of JIA can present with fever, hepatosplenomegaly, lymphadenopathy, and high inflammatory markers.
- Sarcoidosis: A rare condition in children, but it can cause lymphadenopathy, hepatosplenomegaly, and chronic fever, along with elevated inflammatory markers.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Lymphoma (despite negative bone marrow aspiration): Although the bone marrow aspiration did not suggest leukemia or lymphoma, these conditions can sometimes have atypical presentations or be missed on initial testing. Lymphoma is a critical diagnosis to consider due to its potential for rapid progression and the need for prompt treatment.
- Histiocytosis (e.g., Langerhans cell histiocytosis): This condition can present with a variety of systemic symptoms including fever, hepatosplenomegaly, and lymphadenopathy, and can be life-threatening if not recognized and treated appropriately.
- Rare diagnoses:
- Castleman Disease: A rare disorder that can cause lymphadenopathy, hepatosplenomegaly, and systemic inflammation.
- Kawasaki Disease (atypical presentation): Although typically associated with specific clinical criteria, atypical presentations can occur, and it's essential to consider this diagnosis due to its potential for causing coronary artery aneurysms if not treated.
- Chronic Granulomatous Disease (CGD): An immunodeficiency that can lead to recurrent infections and granulomatous inflammation, potentially presenting with the described symptoms.