Differential Diagnosis

The patient's complex presentation of chronic health issues, including gradual onset fatigue, steatorrhea, unexplained weight loss, and neurological symptoms, requires a comprehensive differential diagnosis. The following categories outline potential diagnoses:

• Single Most Likely Diagnosis
  • Chronic Parasitic Infection (e.g., hookworm, roundworm, or tapeworm): The patient's history of extended travel and residence in West Africa, south and southeast Asia, and exposure to domestic and farm animals increases the risk of parasitic infections. The improvement in symptoms and eGFR after using wormwood, clove, and black walnut extracts, which have antiparasitic properties, supports this diagnosis. The patient's chronic fatigue, weight loss, and gastrointestinal symptoms are consistent with a chronic parasitic infection.
• Other Likely Diagnoses
  • Vitamin B12 Deficiency: Although the patient's B12 level is 166 pmol/L, which is within the normal range, the improvement in symptoms after starting B12 IM EOD supplementation suggests that the patient may have a functional B12 deficiency or impaired utilization.
  • Zinc Deficiency: The patient's consistently low zinc levels despite supplementation may contribute to the patient's symptoms, including impaired wound healing, immune dysfunction, and neurological issues.
  • Chronic Inflammatory Disease (e.g., Crohn's disease, ulcerative colitis): The patient's symptoms of steatorrhea, weight loss, and abdominal pain could be indicative of a chronic inflammatory disease, although the normal CRP and liver enzymes make this less likely.
• Do Not Miss Diagnoses
  • HIV/AIDS: Although the patient tested negative for HIV, it is essential to consider this diagnosis due to the patient's history of travel to high-risk areas and the presence of symptoms such as weight loss, fatigue, and neurological issues.
  • Tuberculosis: The patient's history of travel to high-risk areas and the presence of symptoms such as weight loss, fatigue, and cough (not explicitly mentioned but possible) make it essential to consider this diagnosis.
  • Lymphoma: The patient's chronic fatigue, weight loss, and abnormal blood markers (e.g., low WBC, elevated SHBG) could be indicative of a lymphoma, which would require prompt diagnosis and treatment.
• Rare Diagnoses
  • Whipple's Disease: This rare bacterial infection can cause chronic diarrhea, weight loss, and neurological symptoms, although it is typically associated with a more acute presentation.
  • Tropical Sprue: This rare condition is characterized by chronic diarrhea, weight loss, and malabsorption, often associated with travel to tropical areas.
  • Kala-Azar (Visceral Leishmaniasis): Although the patient's symptoms do not entirely align with this diagnosis, the history of travel to endemic areas and the presence of symptoms such as weight loss, fatigue, and splenomegaly (not explicitly mentioned but possible) make it a consideration.