Differential Diagnosis for Fever with Conjugated Bilirubinemia and Elevated Alkaline Phosphatase
Single Most Likely Diagnosis
- Viral Hepatitis: This condition is characterized by inflammation of the liver, often caused by viral infections (such as hepatitis A, B, or C), which can lead to fever, elevated conjugated bilirubin levels due to liver dysfunction, and increased alkaline phosphatase levels indicating cholestasis or liver cell damage.
Other Likely Diagnoses
- Cholangitis: An infection of the bile duct, which can cause fever, jaundice (due to conjugated bilirubinemia), and elevated alkaline phosphatase levels due to bile duct obstruction or inflammation.
- Drug-Induced Liver Injury (DILI): Certain medications can cause liver injury, leading to symptoms such as fever, elevated liver enzymes (including alkaline phosphatase), and conjugated bilirubinemia.
- Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver characterized by a progressive destruction of the bile ducts within the liver, leading to cholestasis, elevated alkaline phosphatase, and potentially fever in advanced stages.
Do Not Miss Diagnoses
- Ascending Cholangitis with Obstruction: A serious condition where an obstruction in the bile duct (e.g., due to gallstones) leads to infection, which can present with fever, jaundice, and elevated alkaline phosphatase. Prompt diagnosis and treatment are crucial to prevent sepsis and death.
- Hepatic Abscess: A pocket of pus in the liver, often due to bacterial infection, which can cause fever, right upper quadrant pain, and elevated liver enzymes, including alkaline phosphatase.
Rare Diagnoses
- Primary Sclerosing Cholangitis (PSC): A rare chronic liver disease characterized by inflammation and scarring of the bile ducts, which can lead to cholestasis, elevated alkaline phosphatase, and potentially fever.
- Alagille Syndrome: A genetic disorder that affects the liver, heart, and other parts of the body, characterized by a reduction in the number of bile ducts within the liver, leading to cholestasis and elevated liver enzymes.
- Budd-Chiari Syndrome: A rare condition caused by occlusion of the hepatic veins or the inferior vena cava, leading to liver enlargement, ascites, and abdominal pain, with potential for fever and elevated liver enzymes in some cases.