Differential Diagnosis for Prolonged Fever and Elevated Liver Enzymes
The patient's presentation of fever for 12 days along with elevated liver enzymes suggests a range of potential diagnoses. These can be categorized based on their likelihood and the urgency of diagnosis.
Single Most Likely Diagnosis
- Viral hepatitis: This is a common cause of elevated liver enzymes and can be accompanied by systemic symptoms such as fever. The prolonged fever could be indicative of a more severe or acute form of hepatitis.
Other Likely Diagnoses
- Infectious mononucleosis: Caused by Epstein-Barr virus, this condition often presents with fever, fatigue, and elevated liver enzymes.
- Bacterial infections (e.g., sepsis, abscesses): Certain bacterial infections can cause both fever and liver enzyme elevation, either through direct liver involvement or as a systemic response.
- Autoimmune hepatitis: Although less common, autoimmune hepatitis can present with elevated liver enzymes and systemic symptoms like fever, especially in its acute phase.
Do Not Miss Diagnoses
- Sepsis or severe bacterial infections: These conditions are life-threatening and require immediate intervention. The presence of fever and elevated liver enzymes could be indicative of a severe infection affecting the liver or causing a systemic inflammatory response.
- Malignancies (e.g., lymphoma): Certain cancers, particularly those affecting the liver or the lymphatic system, can present with prolonged fever and elevated liver enzymes.
- Wilson's disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver enzyme elevation and systemic symptoms. Although rare, missing this diagnosis can lead to severe liver damage.
Rare Diagnoses
- Leptospirosis: A zoonotic infection that can cause liver enzyme elevation and fever, among other symptoms.
- Brucellosis: Another zoonotic infection that can present with fever, liver enzyme elevation, and other systemic symptoms.
- Toxoplasmosis: In immunocompromised patients, toxoplasmosis can cause liver enzyme elevation and prolonged fever.
- Hemophagocytic lymphohistiocytosis (HLH): A rare and potentially life-threatening condition characterized by excessive immune activation, which can present with fever, liver enzyme elevation, and other systemic symptoms.
Each of these diagnoses requires careful consideration of the patient's history, physical examination, laboratory results, and potentially imaging studies to determine the most appropriate diagnosis and treatment plan.