Differential Diagnosis
The patient presents with fever, night sweats, elevated liver enzymes, and abnormal hematological parameters. Based on the provided laboratory results and clinical presentation, the differential diagnosis can be categorized as follows:
- Single most likely diagnosis
- Hodgkin Lymphoma: The combination of fever, night sweats, elevated LDH, and lymphocytosis, along with a significant drop in hemoglobin and low haptoglobin levels, suggests a hematological malignancy. Hodgkin lymphoma is a common cause of these symptoms in young adults.
- Other Likely diagnoses
- Non-Hodgkin Lymphoma: Similar to Hodgkin lymphoma, non-Hodgkin lymphoma can present with systemic symptoms like fever and night sweats, along with abnormal laboratory findings such as elevated LDH and lymphocytosis.
- Infectious Mononucleosis (despite negative mono test): Although the mono test is negative, infectious mononucleosis can sometimes present with atypical laboratory results. The presence of fever, night sweats, and lymphocytosis keeps this diagnosis in consideration.
- Autoimmune Hemolytic Anemia (AIHA): The low haptoglobin level and drop in hemoglobin suggest hemolysis. AIHA could be a cause, especially with the presence of lymphocytosis, which might indicate an underlying autoimmune process.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Tuberculosis: Although less likely given the normal CRP and the absence of other specific symptoms, tuberculosis can present with fever, night sweats, and hematological abnormalities. It's crucial to consider this diagnosis due to its potential severity and the need for specific treatment.
- Sepsis: Any patient presenting with fever and systemic symptoms should be evaluated for sepsis, especially if there's a risk of bacterial infection. The normal CRP might lower the suspicion, but sepsis can present atypically.
- Rare diagnoses
- Lymphoma-associated Hemophagocytic Lymphohistiocytosis (HLH): This is a rare but life-threatening condition that can occur in association with lymphoma. The presence of fever, night sweats, elevated LDH, and cytopenias could suggest HLH, especially if there's evidence of hemophagocytosis on bone marrow biopsy.
- Primary Liver Lymphoma: Although rare, primary liver lymphoma could explain the elevated liver enzymes and bilirubin levels in the context of a lymphoproliferative disorder.