Differential Diagnosis for Acute Onset Cirrhosis with Ascites
Single Most Likely Diagnosis
- Hemophagocytic Lymphohistiocytosis (HLH): This condition is characterized by hyperferritinemia, which is a key finding in this patient. The presence of bicytopenia, ascites, and a vague cough also supports this diagnosis, as HLH can cause multi-organ dysfunction.
Other Likely Diagnoses
- Viral Hepatitis: Acute viral hepatitis can cause rapid progression to cirrhosis, especially in cases of hepatitis B or D. The presence of ascites and low SAAG (serum-ascites albumin gradient) suggests portal hypertension, which can be seen in cirrhosis due to viral hepatitis.
- Autoimmune Hepatitis: This condition can cause acute liver failure and cirrhosis, and may be associated with extrahepatic manifestations such as cough. The presence of hyperferritinemia and bicytopenia can also be seen in autoimmune hepatitis.
- Wilson's Disease: This genetic disorder can cause acute liver failure and cirrhosis, and may be associated with hemolytic anemia (leading to bicytopenia) and hyperferritinemia.
Do Not Miss Diagnoses
- Malignancy (e.g. Lymphoma): Malignancies, particularly lymphoma, can cause cirrhosis, ascites, and hyperferritinemia. A vague cough can also be a presenting symptom of lymphoma.
- Tuberculosis: TB can cause cirrhosis, ascites, and hyperferritinemia, and is often associated with a chronic cough. Although less likely, TB is a diagnosis that should not be missed due to its potential for severe consequences if left untreated.
- Budd-Chiari Syndrome: This condition, caused by hepatic vein thrombosis, can lead to acute liver failure and cirrhosis. Although less likely, it is a diagnosis that should not be missed due to its potential for severe consequences if left untreated.
Rare Diagnoses
- Gaucher's Disease: This genetic disorder can cause liver dysfunction, including cirrhosis, and may be associated with hyperferritinemia and bicytopenia.
- Niemann-Pick Disease: This rare genetic disorder can cause liver dysfunction, including cirrhosis, and may be associated with hyperferritinemia and bicytopenia.
- Primary Biliary Cholangitis: This autoimmune disease can cause cirrhosis, but is less likely to cause acute onset cirrhosis with ascites and hyperferritinemia.