Differential Diagnosis for Adolescent with Abdominal Pain, Weight Loss, and Decreased LDH
- The patient's symptoms of abdominal pain and weight loss, combined with decreased LDH, can be indicative of various conditions. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Inflammatory Bowel Disease (IBD): Decreased LDH can be seen in conditions with malabsorption or chronic disease, and IBD (such as Crohn's disease or ulcerative colitis) is a common cause of abdominal pain and weight loss in adolescents. The decreased LDH might reflect malabsorption or a chronic response rather than an acute increase often seen in tissue injury.
Other Likely Diagnoses
- Celiac Disease: An autoimmune reaction to gluten leading to malabsorption, which can cause abdominal pain, weight loss, and potentially altered LDH levels due to malabsorption and chronic disease.
- Gastrointestinal Infections: Certain infections (e.g., Helboacter pylori) can cause chronic abdominal pain and weight loss. Decreased LDH might not be a direct consequence but could be seen in the context of chronic infection and malabsorption.
- Hormonal Imbalances: Conditions like hyperthyroidism can lead to weight loss and abdominal pain. Although not directly related to LDH levels, the overall clinical picture could fit.
Do Not Miss Diagnoses
- Cancer (e.g., Lymphoma): Although less common, certain types of cancer can present with abdominal pain, weight loss, and alterations in various blood tests, including potentially decreased LDH due to tumor effects on metabolism or malabsorption.
- Pernicious Anemia: Leading to malabsorption of vitamin B12, which can cause weight loss and abdominal symptoms. The decreased LDH could be related to the chronic disease state.
- Autoimmune Disorders (e.g., Autoimmune Enteropathy): Rare conditions that can cause severe gastrointestinal symptoms, malabsorption, and potentially alterations in LDH levels.
Rare Diagnoses
- Mitochondrial Disorders: Conditions like Kearns-Sayre Syndrome can affect energy production within cells, potentially leading to decreased LDH levels (as LDH is involved in energy production pathways) and a variety of systemic symptoms including abdominal pain and weight loss.
- Congenital Disorders of Glycosylation: Rare genetic disorders affecting protein glycosylation, which can lead to a wide range of symptoms including gastrointestinal issues, potentially resulting in the patient's presentation.
- Chronic Infectious Diseases (e.g., Tuberculosis): Although more common in certain populations, chronic infectious diseases can cause chronic abdominal pain, weight loss, and potentially affect LDH levels indirectly through chronic disease and malabsorption mechanisms.