Differential Diagnosis for 53 yo Male with Elevated LFTs and Neutrophilia
Single Most Likely Diagnosis
- Alcoholic Hepatitis: Given the elevated liver function tests (LFTs) with a pattern of AST being higher than ALT, and the presence of neutrophilia, alcoholic hepatitis is a strong consideration. The patient's age and the lab results support this diagnosis, although a detailed history of alcohol use would be necessary for confirmation.
Other Likely Diagnoses
- Bacterial Cholangitis: The elevated LFTs and neutrophilia could suggest a bacterial infection of the biliary tract. The decrease in WBC count over two weeks might indicate a response to the infection or its treatment.
- Pyogenic Liver Abscess: This condition could explain the elevated LFTs, neutrophilia, and the left shift, suggesting a bacterial infection. Imaging studies like ultrasound or CT scan would be necessary to confirm.
- Diverticulitis or Other Intra-abdominal Infections: These conditions can cause neutrophilia and elevated LFTs if the infection involves the liver or biliary system indirectly.
Do Not Miss Diagnoses
- Sepsis: Although the WBC count decreased over two weeks, any sign of infection, especially with neutrophilia and left shift, warrants consideration of sepsis, which can be life-threatening if not promptly treated.
- Hemophagocytic Lymphohistiocytosis (HLH): This rare but potentially fatal condition can present with elevated LFTs, neutrophilia, and other systemic symptoms. It requires early recognition and treatment.
- Acute Mesenteric Ischemia: This condition can cause elevated LFTs and significant neutrophilia due to bowel ischemia. It is a medical emergency requiring prompt diagnosis and intervention.
Rare Diagnoses
- Weil's Disease (Leptospirosis): This zoonotic infection can cause elevated LFTs and neutrophilia. It's rare but should be considered in patients with exposure to contaminated water or animals.
- Echinococcal (Hydatid) Disease: Involvement of the liver by Echinococcus granulosus can cause elevated LFTs and eosinophilia, although neutrophilia can also be present. This diagnosis would be more likely in individuals with a history of travel to endemic areas.
- Amebic Liver Abscess: Caused by Entamoeba histolytica, this condition can present with right upper quadrant pain, fever, and elevated LFTs. Neutrophilia may be present, and it's more common in travelers to or immigrants from endemic areas.