Differential Diagnosis for a 65-year-old Male with Pancytopenia and High-Grade Fever
Single Most Likely Diagnosis
- Septicemia or Sepsis: This condition is a leading cause of pancytopenia and high-grade fever in elderly patients due to the body's overwhelming response to an infection, which can suppress bone marrow function.
Other Likely Diagnoses
- Aplastic Anemia: Although less common, aplastic anemia can present with pancytopenia and may be accompanied by fever, especially if there is an associated infection.
- Viral Infections (e.g., HIV, EBV, CMV): Certain viral infections can cause bone marrow suppression leading to pancytopenia and are often accompanied by fever.
- Myelodysplastic Syndromes (MDS): These are a group of disorders caused by poorly formed or dysfunctional blood cells, which can lead to pancytopenia and may present with fever due to associated infections or disease progression.
- Leukemia (Acute or Chronic): Leukemias can cause pancytopenia due to bone marrow infiltration by malignant cells and may present with fever, either due to the disease itself or secondary infections.
Do Not Miss Diagnoses
- Disseminated Tuberculosis: Although less common in some regions, TB can cause pancytopenia and high-grade fever, and missing this diagnosis can be fatal if not treated promptly.
- Brucellosis: This zoonotic infection can lead to pancytopenia and fever and is critical not to miss due to its treatable nature with appropriate antibiotics.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare but life-threatening condition characterized by excessive immune activation, which can present with pancytopenia and fever, requiring immediate recognition and treatment.
Rare Diagnoses
- Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, bone marrow failure, and the potential for thrombotic events, which can occasionally present with pancytopenia and fever.
- Lymphoma: Certain types of lymphoma can infiltrate the bone marrow, leading to pancytopenia, and may present with systemic symptoms including fever.
- Multiple Myeloma: A plasma cell disorder that can lead to bone marrow failure and pancytopenia, often accompanied by fever, especially in advanced stages or with associated infections.