Differential Diagnosis
- Single most likely diagnosis
- Hepatitis A or E: The patient's symptoms, including loss of appetite, headache, diarrhea, intermittent fever, and hepatomegaly, are consistent with hepatitis. The fact that she recently returned from a subtropical location, where hepatitis A and E are more common, and drank only bottled water, which reduces the risk of other waterborne illnesses, supports this diagnosis.
- Other Likely diagnoses
- Typhoid fever: Although the patient reported proper hand hygiene, typhoid fever is still a possibility, especially given her recent travel to a subtropical location. Symptoms such as fever, headache, and diarrhea are consistent with typhoid fever.
- Malaria: Despite the patient's report of drinking only bottled water, malaria is a consideration given her travel history. However, the absence of specific symptoms such as cyclical fevers and chills makes this diagnosis less likely.
- Dengue fever: This illness is common in subtropical regions and can cause symptoms such as fever, headache, and diarrhea. However, the presence of hepatomegaly is not typically a dominant feature of dengue fever.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malaria: As mentioned earlier, malaria is a potentially life-threatening illness that requires prompt diagnosis and treatment.
- Viral hemorrhagic fever (e.g., Lassa fever, Ebola): Although the patient's symptoms do not strongly suggest viral hemorrhagic fever, it is essential to consider this possibility given her travel history and the potential for severe consequences if missed.
- Leptospirosis: This bacterial infection can cause symptoms such as fever, headache, and diarrhea, and can lead to severe complications, including liver and kidney failure, if left untreated.
- Rare diagnoses
- Schistosomiasis: This parasitic infection can cause symptoms such as fever, diarrhea, and hepatomegaly, but it is relatively rare and typically associated with exposure to contaminated water, which the patient reported avoiding.
- Amoebic liver abscess: This condition can cause symptoms such as fever, diarrhea, and hepatomegaly, but it is relatively rare and typically associated with specific risk factors, such as travel to endemic areas or immunocompromised status.