Differential Diagnosis for Left Upper Quadrant Abdominal Mass in a Young Patient with Epstein Barr Virus
Single Most Likely Diagnosis
- Infectious Mononucleosis (Mono) with Splenomegaly: This is the most likely diagnosis given the patient's age and the presence of Epstein Barr virus (EBV). EBV is the primary cause of infectious mononucleosis, which often presents with fever, sore throat, fatigue, and splenomegaly, leading to a left upper quadrant abdominal mass.
Other Likely Diagnoses
- Lymphoma: Although less common than infectious mononucleosis, lymphoma can present with systemic symptoms similar to mono and can cause splenomegaly. EBV is associated with certain types of lymphoma, making this a plausible diagnosis.
- Splenomegaly due to Other Infections: Other infections, such as malaria, tuberculosis, or bacterial endocarditis, can cause splenomegaly. However, the presence of EBV points more strongly towards infectious mononucleosis.
Do Not Miss Diagnoses
- Splenic Rupture: This is a medical emergency that can occur in the setting of splenomegaly due to any cause, including infectious mononucleosis. It presents with severe abdominal pain and can be life-threatening if not promptly treated.
- Splenomegaly due to Leukemia: Leukemias, such as chronic lymphocytic leukemia (CLL) or chronic myeloid leukemia (CML), can cause significant splenomegaly. Although less likely in a young patient with EBV, missing this diagnosis could have severe consequences.
Rare Diagnoses
- Splenic Cysts or Abscesses: These can cause a left upper quadrant mass but are less common and not typically associated with EBV infection.
- Gaucher's Disease: A rare genetic disorder that can cause splenomegaly due to the accumulation of glucocerebroside in the spleen. It is not directly related to EBV but could be considered in the differential diagnosis of splenomegaly in a young patient.
- Lymphoproliferative Disorders: Rare conditions, some of which are associated with EBV, that can cause splenomegaly and lymphadenopathy. Examples include post-transplant lymphoproliferative disorder (PTLD).