Differential Diagnosis for a 5-year-old Child with Stomach Pain, Mesenteric Lymphadenitis, Elevated Liver Enzymes, and Coagulopathy
Single Most Likely Diagnosis
- Viral hepatitis: This diagnosis is likely due to the combination of stomach pain, mesenteric lymphadenitis (which can be associated with viral infections), elevated liver enzymes indicating liver inflammation, and coagulopathy (increased PT, INR, APTT) which can occur in severe liver disease. Low albumin levels also support liver dysfunction.
Other Likely Diagnoses
- Autoimmune hepatitis: This condition can present with elevated liver enzymes, coagulopathy, and low albumin levels. It is an immune-mediated disease that can cause liver inflammation and may be associated with abdominal pain.
- Wilson's disease: Although less common, Wilson's disease can cause liver dysfunction (elevated liver enzymes, low albumin), coagulopathy, and abdominal pain. It is an inherited disorder that leads to copper accumulation in the liver.
- Infectious mononucleosis: Caused by Epstein-Barr virus, it can lead to mesenteric lymphadenitis, liver enzyme elevation, and occasionally, coagulopathy. However, the presence of significant coagulopathy and low albumin might be less typical.
Do Not Miss Diagnoses
- Acute liver failure due to any cause (e.g., toxin, drug, or viral infection): This is a medical emergency that requires prompt recognition and treatment. The presence of coagulopathy, elevated liver enzymes, and low albumin levels necessitates considering acute liver failure.
- Sepsis or severe bacterial infection: Although the presentation might not be typical, sepsis can cause multi-organ dysfunction, including liver enzyme elevation, coagulopathy, and low albumin levels. It's crucial to consider and rule out sepsis due to its high mortality if untreated.
- Budd-Chiari syndrome: This rare condition involves hepatic vein thrombosis, which can cause abdominal pain, liver dysfunction, and coagulopathy. It's essential to consider due to its potential for severe outcomes if not treated.
Rare Diagnoses
- Lymphoma: Although rare in children, lymphoma can cause mesenteric lymphadenitis, liver enzyme elevation, and systemic symptoms. It would be an unusual cause of coagulopathy and low albumin but should be considered in the differential diagnosis.
- Vascular malformations or thrombophilic disorders: These conditions can lead to liver vein or portal vein thrombosis, resulting in liver dysfunction and coagulopathy. They are rare but important to consider due to their specific treatment requirements.
- Congenital disorders of glycosylation: These are a group of rare genetic disorders that can affect liver function and coagulation, among other systems. They might present with a complex picture including liver enzyme elevation, coagulopathy, and low albumin levels.