Differential Diagnosis for a 10-year-old Female with TLC 10000 and 70% Neutrophils

• Single most likely diagnosis:
  • Acute Bacterial Infection (e.g., pneumonia, urinary tract infection, or skin infection): This is the most likely diagnosis given the elevated white blood cell count (TLC 10000) with a predominance of neutrophils (70%), which typically indicates a bacterial infection.
• Other Likely diagnoses:
  • Viral Infection: Although the high percentage of neutrophils might suggest a bacterial infection, some viral infections can also present with neutrophilia, especially in the early stages.
  • Inflammatory Condition: Conditions like appendicitis or inflammatory bowel disease could also lead to an elevated neutrophil count.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Neutrophilic Leukemia: Although rare, leukemia can present with an elevated white blood cell count and should be considered to avoid missing a potentially life-threatening condition.
  • Sepsis: If the bacterial infection has progressed to sepsis, it's crucial to identify and treat promptly as it can be life-threatening.
  • Meningitis: Bacterial meningitis is a medical emergency that requires immediate attention. The symptoms might not always be clear-cut, especially in children.
• Rare diagnoses:
  • Chronic Granulomatous Disease: A rare genetic disorder that affects the immune system, leading to recurrent infections.
  • Leukocyte Adhesion Deficiency: A rare condition that affects the body's ability to fight infection due to problems with white blood cell adhesion.