Differential Diagnosis
- Single most likely diagnosis
- Drug-Induced Liver Injury (DILI): Given the patient's recent use of NSAIDs, celecoxib, steroids, and ciprofloxacin, followed by the development of jaundice, encephalopathy, and significantly elevated liver enzymes (ALT and AST), DILI is the most plausible diagnosis. The temporal relationship between drug intake and liver dysfunction supports this diagnosis.
- Other Likely diagnoses
- Acute Viral Hepatitis: Although virology for A, B, and C is reported as normal, it's essential to consider other viral hepatitis types (like E) or the possibility of a false-negative result, especially given the clinical presentation.
- Autoimmune Hepatitis: This condition can present with elevated liver enzymes and might be triggered by drug use. The absence of abdominal pain and the presence of encephalopathy could suggest a severe form of the disease.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Wilson's Disease: Although rare, Wilson's disease can present with liver dysfunction, encephalopathy, and Kayser-Fleischer rings. It's crucial to consider this diagnosis due to its potential for severe outcomes if not treated promptly.
- Budd-Chiari Syndrome: This condition, characterized by hepatic vein thrombosis, can lead to liver dysfunction and encephalopathy. Given the patient's presentation, it's essential to rule out vascular causes of liver injury.
- Rare diagnoses
- Reye's Syndrome: A rare but serious condition that causes swelling in the liver and brain, often associated with the use of aspirin during viral infections. Although the patient's age and presentation might not perfectly align with typical Reye's syndrome cases, it remains a consideration in the differential diagnosis due to the use of NSAIDs and the development of encephalopathy.
- Ischemic Hepatitis: This condition occurs due to a reduction in blood flow to the liver and can result in elevated liver enzymes. It might be considered if there were any episodes of hypotension or cardiac dysfunction, although the patient's presentation does not strongly suggest this.