Differential Diagnosis
The patient's laboratory results show an elevated high-sensitivity C-reactive protein (HsCRP) level of 22.30, an elevated white blood cell (WBC) count of 14.9, a high percentage of neutrophils (82.5%), a low percentage of lymphocytes (8.9%), an elevated absolute neutrophil count (12.3), and a slight elevation in absolute immature granulocytes (0.3). Based on these findings, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Bacterial infection: The elevated WBC count with a predominance of neutrophils and an elevated HsCRP level suggests an acute bacterial infection. The body's response to bacterial infections often includes an increase in neutrophil production and the release of inflammatory markers like CRP.
Other Likely Diagnoses
- Acute inflammatory condition: Conditions such as acute appendicitis, cholecystitis, or diverticulitis could present with similar laboratory findings due to the body's inflammatory response.
- Sepsis: Although the absolute immature granulocyte count is not significantly elevated, sepsis should be considered, especially if the patient shows signs of systemic infection and organ dysfunction.
- Chronic inflammatory disease flare: Conditions like rheumatoid arthritis or inflammatory bowel disease could cause an elevation in inflammatory markers and WBC count during a flare.
Do Not Miss Diagnoses
- Sepsis with a poor prognosis: Even though sepsis might not be the first consideration due to the relatively low absolute immature granulocyte count, it is crucial not to miss this diagnosis due to its high mortality rate if not promptly treated.
- Neutrophilic leukemia: Although rare, an elevated WBC count with a high percentage of neutrophils could be indicative of a myeloproliferative disorder, which would require immediate attention.
- Severe pneumonia: Community-acquired or hospital-acquired pneumonia could present with these laboratory findings, especially if caused by a virulent pathogen.
Rare Diagnoses
- Myeloproliferative neoplasm: Disorders like essential thrombocythemia, polycythemia vera, or primary myelofibrosis could lead to an elevated WBC count, though they would typically be associated with other specific findings.
- Leukemoid reaction: A rare, extreme response to infection or inflammation that mimics leukemia but is not a malignant process.
- Autoimmune disorders with secondary infection: Certain autoimmune conditions could lead to an elevated WBC count and inflammatory markers, especially if there is a concurrent infection.