Differential Diagnosis for a 7-Year-Old Child with Chronic Fever, Hepatosplenomegaly, and Lymphadenopathy
- Single Most Likely Diagnosis
- Tuberculosis (TB): Despite a negative CBNAAT for AFB and completion of 1 year of ATT, TB remains a strong consideration due to the clinical presentation of chronic fever, hepatosplenomegaly, and lymphadenopathy. The persistence of symptoms despite treatment could indicate drug-resistant TB, incomplete treatment, or a non-tubercular mycobacterial infection.
- Other Likely Diagnoses
- Autoimmune Lymphoproliferative Syndrome (ALPS): This condition is characterized by chronic lymphadenopathy, hepatosplenomegaly, and autoimmune cytopenias, which could fit the clinical picture, especially given the lack of response to ATT and negative tests for common infections.
- Chronic Granulomatous Disease (CGD): This immunodeficiency disorder can present with recurrent infections, granulomatous disease, and chronic inflammation, which might explain the hepatosplenomegaly and lymphadenopathy.
- Sarcoidosis: Although rare in children, sarcoidosis can cause lymphadenopathy, hepatosplenomegaly, and chronic fever, along with elevated inflammatory markers.
- Do Not Miss Diagnoses
- Lymphoma: Although the bone marrow aspiration did not suggest leukemia or lymphoma, it is crucial to consider and rule out lymphoma thoroughly, possibly with additional imaging or biopsies, 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 wide range of symptoms, including chronic fever, hepatosplenomegaly, and lymphadenopathy, and is critical to diagnose due to its potential for severe outcomes if left untreated.
- Rare Diagnoses
- Castleman Disease: A rare disorder that can cause lymphadenopathy, hepatosplenomegaly, and systemic inflammation, which might fit the clinical presentation.
- 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 cardiac complications.
- Primary Immunodeficiency Diseases (e.g., Hyper-IgM Syndrome): These conditions can lead to recurrent infections and chronic inflammation, which might explain the child's symptoms.