Differential Diagnosis for Patient on Dialysis with Fever and Intermittent Loose Stools

• Single most likely diagnosis:
  • Chronic dialysis-related infection (e.g., catheter-related bloodstream infection): This is a common issue in patients undergoing dialysis, especially if they have a catheter in place for dialysis access. The fever that resolves with paracetamol but recurs, particularly after dialysis sessions, suggests an infection related to the dialysis process itself.
• Other Likely diagnoses:
  • Dialyzer reaction or endotoxin-related fever: Some patients may react to the dialyzer material or to endotoxins that can be present in the dialysate, leading to fever after dialysis.
  • Gastroenteritis: The intermittent loose stools could be indicative of a gastrointestinal infection, which might be unrelated to the dialysis but could be exacerbated by the patient's immunocompromised state due to chronic illness.
  • Intra-abdominal infection (e.g., diverticulitis, cholecystitis): Although less directly related to dialysis, these conditions could cause fever and gastrointestinal symptoms and should be considered, especially if the patient has risk factors.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Sepsis: Any patient with a fever, especially one that is recurrent and post-dialysis, should be evaluated for sepsis, which can be life-threatening if not promptly treated.
  • Endocarditis: Patients with vascular access for dialysis are at increased risk of developing endocarditis, which can present with fever and might not always have the classic signs of heart valve infection.
  • Tuberculosis: Although less common, TB can cause chronic fever and gastrointestinal symptoms and is important to consider, especially in patients who may be immunocompromised or have been exposed to TB.
• Rare diagnoses:
  • Hemodialysis-associated amyloidosis: A rare condition where amyloid deposits accumulate due to long-term hemodialysis, potentially causing a variety of symptoms including fever, though it's less directly linked to the symptoms described.
  • Adverse reaction to dialysate or water quality issue: Rarely, issues with the dialysate or water used in dialysis can cause fever and other symptoms in patients undergoing dialysis.