Differential Diagnosis for a Female with Decreased Appetite, Headache, Diarrhea, Intermittent Fever, and Hepatomegaly after Returning from a Subtropical Location

• Single Most Likely Diagnosis
  • Viral Hepatitis: Given the patient's symptoms of decreased appetite, headache, diarrhea, intermittent fever, and particularly hepatomegaly (enlargement of the liver), along with recent travel to a subtropical location, viral hepatitis is a strong consideration. Despite drinking bottled water and practicing proper hand hygiene, the risk of exposure to hepatitis viruses, especially hepatitis A or E which are more common in subtropical regions, cannot be entirely ruled out. Hepatitis A and E are primarily spread through the fecal-oral route, and even with precautions, exposure can occur through contaminated food or close contact with an infected individual.
• Other Likely Diagnoses
  • Typhoid Fever: Caused by Salmonella Typhi, this infection is common in subtropical and tropical regions. Symptoms include fever, headache, diarrhea, and abdominal pain. Although the patient reported drinking bottled water, typhoid fever can also be spread through contaminated food or close contact with an infected person.
  • Malaria: Despite the lack of specific symptoms like chills or a characteristic cyclical pattern of fever, malaria should be considered in anyone returning from a subtropical region, especially if they have hepatomegaly. Malaria can cause a variety of symptoms including fever, diarrhea, and abdominal pain.
• Do Not Miss Diagnoses
  • Leptospirosis: This bacterial infection is spread through water contaminated with the urine of infected animals. Although the patient drank bottled water, exposure could have occurred through swimming or wading in contaminated water or through contact with damp soil or mud. Leptospirosis can cause a wide range of symptoms including fever, headache, and liver enlargement, and it can be severe if not treated promptly.
  • Dengue Fever: A common arboviral disease in tropical and subtropical regions, dengue fever can cause severe flu-like symptoms and, in severe cases, hemorrhagic manifestations. Hepatomegaly can be present, and the disease can be life-threatening if not recognized and managed properly.
• Rare Diagnoses
  • Schistosomiasis (Bilharzia): This parasitic infection is spread through contact with contaminated water. While less likely given the patient's reported avoidance of untreated water, schistosomiasis can cause a variety of symptoms including fever, diarrhea, and liver enlargement due to the parasite's eggs causing inflammation in the liver.
  • Amoebic Liver Abscess: Caused by Entamoeba histolytica, this condition can occur in travelers to endemic areas. Symptoms include fever, right upper quadrant abdominal pain, and hepatomegaly. Although less common than other diagnoses, it should be considered in the differential diagnosis due to the patient's travel history and symptoms.