Differential Diagnosis for a 13-year-old Male with Fatigue, Abdominal Distension, Weight Loss, and Bone Pains
- Single most likely diagnosis:
- Acute Lymphoblastic Leukemia (ALL): This is the most common childhood cancer, and its presentation with fatigue, weight loss, abdominal distension due to hepatosplenomegaly, and bone pains (due to bone marrow infiltration) fits the patient's symptoms. The recent onset of "aches and pains" in the upper arms and hip could indicate bone marrow involvement.
- Other Likely diagnoses:
- Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can present with systemic symptoms such as weight loss, fatigue, and abdominal distension due to lymphadenopathy or hepatosplenomegaly. Bone pain is less common but can occur.
- Chronic Myeloid Leukemia (CML): Though less common in children, CML can cause similar symptoms, including splenomegaly, weight loss, and fatigue. However, bone pains are less typical for CML.
- Do Not Miss diagnoses:
- Sickle Cell Disease with Sepsis or Crisis: Although the patient's symptoms do not strongly suggest sickle cell disease, it's crucial to consider, especially if the patient is of African descent. Sepsis or a sickle cell crisis can present with acute pain episodes, fever (though the patient is afebrile), and potentially life-threatening complications.
- Osteosarcoma or Other Bone Cancers: While less likely given the combination of symptoms, bone cancers can cause pain and could potentially lead to systemic symptoms like weight loss. Metastatic disease could explain the abdominal findings if there's liver involvement.
- Rare diagnoses:
- Langerhans Cell Histiocytosis (LCH): This rare disorder can cause a wide range of symptoms, including bone lesions leading to pain, hepatosplenomegaly, and systemic symptoms like weight loss. It's less common but should be considered in the differential for unexplained multi-system disease.
- Gaucher's Disease: A genetic disorder leading to spleen enlargement, bone pain, and other systemic symptoms due to the accumulation of glucocerebroside. It's rare and might not be the first consideration but could fit some of the patient's symptoms.