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 organize potential diagnoses based on likelihood and clinical significance.

• Single Most Likely Diagnosis
  • Chronic Giardiasis or Other Parasitic Infection: The patient's history of extended travel to West Africa and other regions with poor sanitation, along with symptoms like steatorrhea, weight loss, and fatigue, suggests a chronic parasitic infection. Although Giardia testing was negative, the clinical presentation and response to wormwood, clove, and black walnut extracts (which have antiparasitic properties) support this consideration.
• Other Likely Diagnoses
  • Small Intestine Bacterial Overgrowth (SIBO): Elevated B-Glucuronidase and the presence of symptoms like steatorrhea, bloating, and abdominal pain could indicate SIBO. The patient's improvement with wormwood, clove, and black walnut extracts, which have antimicrobial properties, also supports this diagnosis.
  • Vitamin B12 Deficiency: Although the patient's B12 level is within the normal range, the improvement in symptoms like vision, mental clarity, and mood with B12 supplementation suggests that a functional deficiency or impaired utilization may be present.
  • Helicobacter pylori Infection: The patient has a positive test for H. pylori, which can cause chronic gastrointestinal symptoms and malabsorption. However, the absence of typical symptoms like peptic ulcer disease and the negative virulence factors reduce the likelihood.
• Do Not Miss Diagnoses
  • Lymphoma: The patient's chronic fatigue, weight loss, and low WBC count, despite being non-smoker and non-drinker, warrant consideration of lymphoma. Although the patient's symptoms have improved with supplementation and antiparasitic treatment, lymphoma should be ruled out due to its potential severity.
  • Celiac Disease: The patient's symptoms like steatorrhea, weight loss, and fatigue, along with a low secretory IgA level, could suggest celiac disease. However, the anti-gliadin IgA level is not elevated, reducing the likelihood.
  • Inflammatory Bowel Disease (IBD): The patient's chronic gastrointestinal symptoms and low calprotectin level do not strongly support IBD, but it should be considered due to its potential severity.
• Rare Diagnoses
  • Whipple's Disease: This rare bacterial infection can cause chronic malabsorption, weight loss, and neurological symptoms. Although the patient's symptoms are consistent with Whipple's disease, the diagnosis is rare and would require specific testing.
  • Tropical Sprue: This rare condition, characterized by chronic malabsorption and gastrointestinal symptoms, is typically seen in individuals who have lived in or traveled to tropical regions. The patient's history of travel to West Africa and other regions makes this a possible, although rare, consideration.