Differential Diagnosis
- Single most likely diagnosis
- Acute Intermittent Porphyria (AIP): The patient's history of taking herbal medicine for 15 days, which can induce cytochrome P450 enzymes and thus increase the demand for heme, potentially triggering an acute porphyria attack. The absence of Kayser-Fleischer (KF) rings and low ceruloplasmin levels might initially seem to point away from Wilson's disease, but AIP can present with neurological symptoms and abdominal pain without specific findings like KF rings.
- Other Likely diagnoses
- Wilson's Disease: Although KF rings are absent, Wilson's disease should be considered, especially with low ceruloplasmin levels. The absence of KF rings does not rule out Wilson's disease, particularly in early or mild cases.
- Drug-induced Hepatitis: Herbal medicines can cause liver injury, which might lead to a decrease in ceruloplasmin levels due to liver dysfunction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute Liver Failure: Any condition leading to rapid deterioration of liver function could result in low ceruloplasmin levels and should be considered, especially given the recent history of herbal medicine use, which can be hepatotoxic.
- Fulminant Wilson's Disease: Although less common, fulminant Wilson's disease can present with acute liver failure and hemolysis, and the absence of KF rings does not rule out this diagnosis.
- Rare diagnoses
- Menkes Disease: A rare genetic disorder of copper metabolism characterized by low ceruloplasmin levels, but it typically presents in infancy with severe neurological degeneration and distinctive physical features.
- Aceruloplasminemia: A rare genetic disorder characterized by the complete absence of ceruloplasmin, leading to iron accumulation in the brain and other organs. It usually presents later in life with neurological symptoms and diabetes.