Differential Diagnosis
The patient presents with fatigue, intermittent cough, fever, weight loss, lymphadenopathy, and hepatomegaly, along with abnormal complete blood count (CBC) results. Based on these findings, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Lymphoma: The combination of lymphadenopathy, hepatomegaly, significant weight loss, and abnormal CBC results (notably, a high leukocyte count with a differential that includes a notable lymphocyte percentage) points towards a hematological malignancy. Lymphoma, particularly non-Hodgkin lymphoma, is a common cause of these symptoms in adults.
Other Likely Diagnoses
- Chronic Lymphocytic Leukemia (CLL): CLL can present with lymphadenopathy, hepatosplenomegaly, and anemia, which aligns with some of the patient's symptoms and lab findings.
- Hodgkin Lymphoma: Although less common than non-Hodgkin lymphoma, Hodgkin lymphoma can also present with lymphadenopathy, fever, night sweats, and weight loss, making it a consideration.
- Tuberculosis (TB): Given the patient's symptoms of cough, fever, weight loss, and lymphadenopathy, TB should be considered, especially if the patient has been exposed or has risk factors for TB.
Do Not Miss Diagnoses
- Acute Leukemia: While less likely given the subacute presentation, acute leukemia (e.g., acute myeloid leukemia or acute lymphoblastic leukemia) can present with similar symptoms and lab abnormalities. It's crucial to consider this diagnosis due to its aggressive nature and need for prompt treatment.
- Sepsis or Disseminated Infection: The patient's fever, tachycardia, and elevated leukocyte count could also suggest a severe infection. Given the potential for rapid deterioration, identifying and treating sepsis or a disseminated infection is critical.
- HIV/AIDS: HIV infection can lead to a variety of symptoms including weight loss, fever, and lymphadenopathy, and can also predispose to opportunistic infections and malignancies.
Rare Diagnoses
- Castleman Disease: A rare disorder that can present with lymphadenopathy, fever, weight loss, and hepatosplenomegaly, mimicking lymphoma.
- Histiocytosis: A group of rare diseases involving abnormal proliferation of histiocytes, which can present with systemic symptoms and organ involvement similar to those seen in this patient.
- Sarcoidosis: Although more commonly associated with pulmonary symptoms, sarcoidosis can cause lymphadenopathy, fever, and weight loss, and should be considered in the differential diagnosis, especially if other systemic symptoms are present.