Differential Diagnosis for Elevated Total Bilirubin and Fatigue in an 18-Year-Old Male
Single Most Likely Diagnosis
- Gilbert Syndrome: A benign condition characterized by a mild increase in unconjugated bilirubin levels, often presenting with fatigue and jaundice, particularly during periods of stress, fasting, or illness. The bilirubin level of 1.7 mg/dL is within the range typically seen in Gilbert Syndrome.
Other Likely Diagnoses
- Viral Hepatitis: Acute or chronic infections with hepatitis viruses (A, B, C, D, E) can cause elevations in bilirubin levels and fatigue. The diagnosis would depend on serological tests and liver function tests.
- Hemolytic Anemia: Conditions like autoimmune hemolytic anemia or hereditary spherocytosis can lead to increased bilirubin due to hemolysis. Fatigue would be a symptom due to anemia.
- Alcohol Use: Although less common in an 18-year-old, alcohol consumption can lead to liver dysfunction, causing elevated bilirubin and fatigue.
Do Not Miss Diagnoses
- Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver dysfunction, elevated bilirubin, and fatigue. Early diagnosis is crucial for treatment.
- Hemochromatosis: A genetic disorder causing excessive iron absorption, leading to liver damage, elevated bilirubin, and fatigue. Early detection can prevent long-term complications.
- Autoimmune Hepatitis: A condition where the body's immune system attacks liver cells, potentially causing elevated bilirubin and fatigue. Prompt diagnosis and treatment are essential to prevent liver failure.
Rare Diagnoses
- Dubin-Johnson Syndrome: A rare genetic disorder causing chronic jaundice due to an inability to secrete conjugated bilirubin into the bile. It's characterized by a distinctive black liver due to the accumulation of epinephrine metabolites.
- Crigler-Najjar Syndrome: A rare congenital disorder affecting the enzyme responsible for converting unconjugated bilirubin to conjugated bilirubin, leading to very high levels of unconjugated bilirubin and potentially severe jaundice.
- Porphyrias: A group of rare genetic disorders that can affect the production of heme, a vital molecule for various bodily functions, leading to a variety of symptoms including elevated bilirubin and fatigue.