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Differential Diagnosis for Fever and Headache in a 16-year-old

Single Most Likely Diagnosis

  • Chronic Infectious Mononucleosis: This condition, caused by Epstein-Barr virus (EBV), is common in adolescents and can present with prolonged fever, headache, and other systemic symptoms. The long duration of fever and the presence of headache make this a plausible diagnosis.

Other Likely Diagnoses

  • Tuberculosis (TB): TB can cause chronic fever and headache, especially if it involves the central nervous system (CNS) or is disseminated. The long duration of symptoms and the presence of headache increase the likelihood of TB.
  • Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can present with prolonged fever, night sweats, and weight loss, along with headaches due to CNS involvement or increased intracranial pressure.
  • Chronic Meningitis: This condition, which can be caused by various pathogens including fungi, mycobacteria, and viruses, presents with chronic symptoms such as headache, fever, and sometimes altered mental status.

Do Not Miss Diagnoses

  • Brain Abscess: Although less common, a brain abscess can present with fever and headache and is a medical emergency requiring prompt diagnosis and treatment to prevent severe neurological damage or death.
  • Subarachnoid Hemorrhage: While typically presenting acutely, in some cases, a subarachnoid hemorrhage can have a more insidious onset, with chronic headache and intermittent fever, especially if there is a chronic leak or a condition like an arteriovenous malformation (AVM).
  • Central Nervous System Vasculitis: Conditions like primary CNS vasculitis can present with chronic headache, fever, and other neurological symptoms, and are critical to diagnose early to prevent irreversible damage.

Rare Diagnoses

  • Histoplasmosis: A fungal infection that can cause chronic fever, headache, and other systemic symptoms, particularly in immunocompromised individuals or those exposed to the fungus in endemic areas.
  • Cysticercosis: Caused by the pork tapeworm (Taenia solium), this parasitic infection can lead to neurocysticercosis, presenting with seizures, headaches, and other neurological symptoms, along with chronic fever in some cases.
  • Erdheim-Chester Disease: A rare form of histiocytosis that can involve the CNS and present with chronic symptoms including fever and headache, among other systemic manifestations.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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