Differential Diagnosis for Elevated Liver Enzymes Due to Infection

Elevated liver enzymes can be caused by a variety of infections, each with different pathophysiology and clinical presentations. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Viral Hepatitis (A, B, C, D, E): These viruses directly infect liver cells, leading to inflammation and elevation of liver enzymes. Hepatitis B and C are particularly known for causing chronic infection, which can lead to cirrhosis and liver cancer.

• Other Likely Diagnoses

  • Epstein-Barr Virus (EBV): The cause of infectious mononucleosis, EBV can infect the liver, leading to elevated liver enzymes.
  • Cytomegalovirus (CMV): Especially in immunocompromised patients, CMV can cause hepatitis.
  • Toxoplasmosis: In immunocompromised individuals, toxoplasmosis can reactivate and affect the liver.

• Do Not Miss Diagnoses

  • Herpes Simplex Virus (HSV): Although less common, HSV can cause severe hepatitis, particularly in immunocompromised patients or during pregnancy.
  • Varicella-Zoster Virus: Reactivation of varicella-zoster virus can lead to herpes zoster, which rarely can cause hepatitis.

• Rare Diagnoses

  • Leptospirosis: A zoonotic infection that can cause liver dysfunction among other systemic symptoms.
  • Q Fever: Caused by Coxiella burnetii, it can lead to hepatitis, though it's more commonly known for causing pneumonia.
  • Brucellosis: A zoonotic infection that can involve the liver and cause elevated liver enzymes.
  • Schistosomiasis: Certain species of Schistosoma can cause liver fibrosis and elevation of liver enzymes, particularly in chronic infection.

Each of these infections has a different epidemiology, clinical presentation, and treatment approach. Accurate diagnosis is crucial for appropriate management and prevention of long-term liver damage.