Viral Hepatitis: This is often the first consideration due to its high prevalence and the fact that hepatosplenomegaly is a common presentation in acute and chronic viral hepatitis infections.

Chronic Liver Disease/Cirrhosis: Conditions like alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), and cirrhosis can lead to hepatosplenomegaly due to liver fibrosis and portal hypertension.
Hematological Disorders: Conditions such as lymphoma, leukemia, and myeloproliferative neoplasms can cause hepatosplenomegaly due to infiltration of the liver and spleen by malignant cells.
Portal Vein Thrombosis: This condition can lead to hepatosplenomegaly due to increased pressure in the portal vein system, causing congestion and enlargement of the liver and spleen.

Malaria: Although less common in certain regions, malaria can cause hepatosplenomegaly and is critical to diagnose early due to its high mortality rate if left untreated.
Tuberculosis: Hepatic and splenic involvement in tuberculosis can lead to hepatosplenomegaly, and missing this diagnosis can have severe consequences due to the need for specific antimicrobial therapy.
Lymphoma: Certain types of lymphoma can present with hepatosplenomegaly, and early diagnosis is crucial for effective treatment and prognosis.

Amyloidosis: A condition characterized by the deposition of amyloid proteins in various organs, including the liver and spleen, leading to their enlargement.
Gaucher's Disease: A genetic disorder that can cause hepatosplenomegaly due to the accumulation of glucocerebroside in the liver and spleen.
Sarcoidosis: A systemic granulomatous disease that can rarely cause hepatosplenomegaly due to granulomatous infiltration of the liver and spleen.
Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver that can lead to hepatosplenomegaly, although it is more commonly associated with jaundice and pruritus.