Differential Diagnosis for Elevated Liver Enzymes and Prolonged Fever
Single Most Likely Diagnosis
- Viral Hepatitis: This is often the first consideration due to its prevalence and the direct impact of hepatitis viruses on the liver, leading to elevated liver enzymes. Prolonged fever can accompany the acute phase of the infection.
Other Likely Diagnoses
- Autoimmune Hepatitis: An autoimmune condition where the body's immune system attacks liver cells, leading to inflammation and elevated liver enzymes. Fever can be a systemic symptom.
- Drug-Induced Liver Injury (DILI): Many medications can cause liver injury, leading to elevated liver enzymes. Fever might be part of a systemic reaction or indicative of an underlying infection.
- Infectious Mononucleosis: Caused by Epstein-Barr virus (EBV), it can lead to liver enzyme elevation and is often accompanied by prolonged fever.
- Bacterial Infections: Certain bacterial infections, such as those affecting the biliary tract (e.g., cholangitis), can cause both fever and elevated liver enzymes.
Do Not Miss Diagnoses
- Malignancy: Although less common, liver involvement by metastatic disease or primary liver cancer can cause elevated liver enzymes. Fever can be a paraneoplastic symptom.
- Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver enzyme elevation. Fever might not be a primary symptom but can occur in the context of liver dysfunction.
- Budd-Chiari Syndrome: Thrombosis of the hepatic veins, which can lead to liver enzyme elevation and fever due to liver congestion and potential superimposed infection.
- Vascular Occlusion: Occlusion of the hepatic artery or portal vein can lead to liver infarction, presenting with elevated liver enzymes and fever.
Rare Diagnoses
- Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver characterized by a progressive destruction of the bile ducts within the liver, leading to elevated liver enzymes. Fever is not a typical primary symptom but can occur.
- Primary Sclerosing Cholangitis (PSC): A chronic liver disease characterized by inflammation and scarring of the bile ducts, which can lead to elevated liver enzymes. Fever might be present, especially if there's a superimposed infection.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare disorder of the immune system where the body produces too many activated immune cells called macrophages and lymphocytes, which can lead to elevated liver enzymes and fever among other systemic symptoms.
- Lymphoma: Certain types of lymphoma can involve the liver, leading to elevated liver enzymes. Fever can be a systemic symptom (B symptoms).