Differential Diagnosis for a 2-year-old Male with Hemoptysis, Fatigue, and Muscle Pain
- Single most likely diagnosis
- Acute Lymphoblastic Leukemia (ALL): The presence of petechiae, cervical and axillary adenopathy, splenomegaly, and symptoms like fatigue and muscle pain are highly suggestive of ALL, a common malignancy in children that can cause bone marrow failure and lead to bleeding manifestations like hemoptysis.
- Other Likely diagnoses
- Infectious Mononucleosis: Caused by Epstein-Barr virus, it can present with fever (though the patient is afebrile, this can vary), sore throat, tonsillar enlargement, lymphadenopathy, and splenomegaly. However, hemoptysis is less common.
- Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can present with lymphadenopathy, splenomegaly, and systemic symptoms like fatigue. Hemoptysis could occur if there's pulmonary involvement.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Tuberculosis: Although less likely given the clinical presentation, TB can cause hemoptysis, lymphadenopathy, and systemic symptoms. It's crucial to consider, especially if the patient has been exposed or has risk factors.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A vasculitis that can cause hemoptysis, systemic symptoms, and might have lymphadenopathy. It's rare but critical to diagnose due to its potential for severe organ damage.
- Rare diagnoses
- Langerhans Cell Histiocytosis: Can present with a wide range of symptoms including lymphadenopathy, splenomegaly, and systemic symptoms. Hemoptysis could occur if there's pulmonary involvement.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare disorder of the immune system that can cause systemic symptoms, lymphadenopathy, splenomegaly, and cytopenias. Although hemoptysis is not a common presentation, the disease's severity warrants consideration in a differential diagnosis for a child with a complex presentation.