Differential Diagnosis for 69-year-old Male Patient

The patient presents with a complex array of symptoms and laboratory abnormalities, necessitating a broad differential diagnosis. The following categories organize potential diagnoses based on likelihood and severity:

• Single Most Likely Diagnosis
  • Sepsis: The patient's elevated WBC count with left shift, high lactic acid level, and multiple organ involvement (indicated by elevated troponin, BNP, AST, ALT, and bilirubin) suggest a systemic infection. The recent history of sore throat and generalized body aches further supports this diagnosis. Sepsis can lead to organ dysfunction and failure, which aligns with the patient's low sodium, high potassium, and elevated liver enzymes.
• Other Likely Diagnoses
  • Acute Coronary Syndrome (ACS): Elevated troponin levels indicate myocardial injury, which could be due to ACS, especially in the context of the patient's history of hypertension and hypercholesterolemia. However, the absence of chest pain or shortness of breath makes this less likely.
  • Congestive Heart Failure (CHF): The high BNP level and swelling in the lower extremities suggest possible CHF, exacerbated by the patient's recent alcohol use and potential sepsis.
  • Alcoholic Hepatitis: The patient's chronic alcohol use, elevated liver enzymes (AST > ALT), and bilirubin level are consistent with alcoholic hepatitis.
• Do Not Miss Diagnoses
  • Septic Shock: Although the patient does not currently exhibit hypotension, the presence of sepsis and organ dysfunction (elevated lactic acid, troponin, and BNP) necessitates close monitoring for signs of shock.
  • Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The patient's elevated troponin without typical chest pain symptoms could indicate a myocardial infarction, especially in the context of sepsis or other stressors.
  • Pulmonary Embolism: Despite the absence of reported shortness of breath or chest pain, pulmonary embolism remains a critical diagnosis to consider, especially given the patient's recent immobility and potential for sepsis.
• Rare Diagnoses
  • Adrenal Insufficiency: The patient's low sodium, high potassium, and recent history of depression and alcohol use could suggest adrenal insufficiency, although this is less likely given the absence of other specific symptoms like hypotension or hyperkalemia without other causes.
  • Thyrotoxic Crisis: Although less common, the patient's recent history of depression, alcohol use, and multiple organ involvement could potentially mask symptoms of thyrotoxic crisis, making it a rare but important consideration.