Differential Diagnosis for Jaundice and GI Upset with High Eosinophil Count
Single Most Likely Diagnosis
- Anisakiasis: This parasitic infection, caused by the ingestion of undercooked or raw fish containing Anisakis larvae, can lead to gastrointestinal symptoms, jaundice, and a significant increase in eosinophil count due to the body's immune response to the parasite. The recent ingestion of salad could potentially contain contaminated fish or other seafood.
Other Likely Diagnoses
- Acute Hepatitis A or E: These viral hepatitis infections can cause jaundice and gastrointestinal upset. While they typically do not cause a significant eosinophilia, in some cases, especially with Hepatitis E, an increase in eosinophils can be observed.
- Food Allergy or Intolerance: Certain food allergies or intolerances, particularly those involving shellfish or other seafood that might be hidden in salads, can cause gastrointestinal symptoms and potentially jaundice if there's a significant liver involvement. Eosinophilia can be seen in allergic reactions.
- Drug-Induced Liver Injury (DILI): Although less likely without a clear history of new medication use, DILI can cause jaundice and GI symptoms. Some drugs can induce an eosinophilic reaction as part of the injury process.
Do Not Miss Diagnoses
- Acute Biliary Obstruction: While less likely to cause eosinophilia, conditions such as gallstones or a tumor obstructing the bile duct can lead to jaundice and GI upset. Missing this diagnosis could lead to severe consequences, including infection and liver damage.
- Hepatic Veno-Occlusive Disease: This condition, often associated with certain medications or toxins, can cause jaundice and liver dysfunction. It's crucial not to miss this diagnosis due to its potential severity and the need for specific treatment.
Rare Diagnoses
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause GI symptoms and potentially jaundice if the liver is involved. It's more commonly associated with food allergies or parasitic infections.
- Fascioliasis: Infection with the liver fluke Fasciola hepatica, which can be acquired through eating contaminated watercress or other aquatic plants, can cause biliary obstruction, jaundice, and eosinophilia. This diagnosis is rare in many parts of the world but should be considered based on travel history or dietary habits.
- Toxocariasis: Infection with Toxocara cati or Toxocara canis, typically through contaminated soil or undercooked meat, can cause visceral larva migrans, leading to eosinophilia and potentially liver involvement.