Differential Diagnosis for Hepatomegaly + Eosinophilia + Night Sweats + Weight Loss
Single Most Likely Diagnosis
- Lymphoma: This condition, particularly Hodgkin lymphoma, can present with hepatomegaly due to liver involvement, eosinophilia as a reactive process, night sweats, and weight loss as part of the systemic symptoms (B symptoms). The combination of these symptoms strongly points towards a lymphoproliferative disorder.
Other Likely Diagnoses
- Hypereosinophilic Syndrome (HES): Characterized by persistent eosinophilia, HES can lead to hepatomegaly due to eosinophilic infiltration of the liver. Night sweats and weight loss can occur due to the systemic nature of the disease. However, HES is less likely to cause significant night sweats compared to lymphoma.
- Tropical Eosinophilia: This condition, often associated with parasitic infections like filariasis, can present with eosinophilia, hepatomegaly, and systemic symptoms including weight loss. Night sweats might be less common but can occur in the context of a systemic infection.
- Chronic Eosinophilic Leukemia: A myeloproliferative disorder that can cause hepatomegaly, eosinophilia, and systemic symptoms including night sweats and weight loss due to the proliferation of eosinophilic precursors.
Do Not Miss Diagnoses
- Acute Hepatic Schistosomiasis: Although less common in areas without endemic schistosomiasis, this condition can cause hepatomegaly, eosinophilia (due to the body's reaction to the parasite), and systemic symptoms. It's crucial to consider in patients with a travel history to endemic areas.
- Visceral Leishmaniasis: This parasitic infection can cause hepatomegaly, weight loss, and night sweats. Eosinophilia might not be as prominent, but it's a critical diagnosis to consider due to its severity and the need for specific treatment.
Rare Diagnoses
- Eosinophilic Granuloma with Polyangiitis (Churg-Strauss Syndrome): A form of vasculitis that can present with eosinophilia, hepatomegaly, and systemic symptoms including weight loss and night sweats. It's rare but should be considered in patients with asthma or a history of atopy.
- Idiopathic Hypereosinophilic Syndrome with Hepatic Involvement: A rare condition characterized by eosinophilia without a known cause, leading to organ damage, including the liver, and systemic symptoms.
- Mastocytosis: Although primarily known for cutaneous manifestations, systemic mastocytosis can involve the liver, causing hepatomegaly, and may present with eosinophilia and systemic symptoms like weight loss and night sweats.