Differential Diagnosis for a 67-year-old Male with Elevated Inflammatory Markers and Negative CTA for Pulmonary Embolism
Single Most Likely Diagnosis
- Infection: Given the elevated CRP, WBC, and ESR, an infectious process is highly likely. The patient's age and the degree of elevation of these markers suggest a significant infection, possibly of a bacterial nature, such as pneumonia, urinary tract infection, or skin infection.
Other Likely Diagnoses
- Inflammatory Arthritis: Conditions like rheumatoid arthritis or polymyalgia rheumatica could explain the elevated inflammatory markers. However, the acute presentation and high D-dimer might lean more towards an infectious or thrombotic process.
- Malignancy: Certain cancers can cause elevated inflammatory markers and D-dimer due to associated thrombosis or tumor-related inflammation. A thorough evaluation for malignancy, especially in a 67-year-old, is warranted.
- Autoimmune Disorders: Conditions like lupus or vasculitis could present with elevated inflammatory markers, though the D-dimer level is particularly high for these diagnoses alone.
Do Not Miss Diagnoses
- Aortic Dissection: Although the CTA was negative for pulmonary embolism, it's crucial to ensure it also ruled out aortic dissection, which can present with elevated D-dimer and inflammatory markers due to the aortic injury.
- Deep Vein Thrombosis (DVT): The high D-dimer and negative CTA for PE do not rule out DVT, which requires separate evaluation, typically with ultrasound.
- Severe Intra-abdominal Pathology: Conditions like a perforated viscus or significant intra-abdominal infection could present with these lab findings and would be catastrophic if missed.
Rare Diagnoses
- Thyroid Storm: Though rare, thyroid storm can cause significant elevation in inflammatory markers and D-dimer due to the extreme metabolic state and potential for thrombosis.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare condition characterized by an overactive and inappropriate immune response, leading to elevated inflammatory markers and potentially a high D-dimer.
- Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, activation of the coagulation system, and potentially elevated D-dimer and inflammatory markers.