Differential Diagnosis for Splenomegaly, Fevers, Body Aches, Liver Enzyme Abnormalities, and Fatigue
Single Most Likely Diagnosis
- Lymphoma: This is a strong consideration given the combination of splenomegaly, fevers (especially worsening at night), body aches, and abnormal liver enzymes. Lymphoma can cause systemic symptoms like fever and fatigue, and splenomegaly is a common finding. The worsening of fevers at night is particularly suggestive of lymphoma.
Other Likely Diagnoses
- Infectious Mononucleosis: Caused by Epstein-Barr virus (EBV), it can lead to splenomegaly, fever, fatigue, and liver enzyme abnormalities. Although fevers worsening at night are not as characteristic, the overall clinical picture can fit.
- Tuberculosis (TB): TB can cause splenomegaly, fevers (which can worsen at night), body aches, and fatigue. Liver enzyme abnormalities can also occur, especially if the TB is disseminated.
- Chronic Lymphocytic Leukemia (CLL): CLL can present with splenomegaly, fatigue, and less commonly, fevers and liver enzyme abnormalities. The worsening of symptoms at night is less typical but can occur.
Do Not Miss Diagnoses
- Sepsis: Although less likely given the chronic nature of the symptoms, sepsis can cause all the mentioned symptoms, including worsening fevers at night. It's critical to rule out sepsis due to its high mortality rate if untreated.
- Endocarditis: Infective endocarditis can cause fever, fatigue, splenomegaly, and embolic phenomena that might lead to body aches. Liver enzyme abnormalities can occur due to emboli or the infection itself.
- HIV/AIDS: HIV infection can lead to splenomegaly, chronic fevers, fatigue, and liver enzyme abnormalities due to the infection itself or opportunistic infections.
Rare Diagnoses
- Sarcoidosis: Although more commonly associated with lung and lymph node involvement, sarcoidosis can cause splenomegaly, fever, fatigue, and liver enzyme abnormalities. It's less likely but should be considered in the differential.
- Histiocytosis: Rare disorders like Langerhans cell histiocytosis can cause splenomegaly, systemic symptoms like fever and fatigue, and liver enzyme abnormalities.
- Primary Sclerosing Cholangitis (PSC): A chronic liver disease that can cause liver enzyme abnormalities and, less commonly, splenomegaly. Systemic symptoms like fever and fatigue can occur, especially if there's associated inflammatory bowel disease.