Differential Diagnosis
The patient's presentation of a productive cough, stiffness and pain in her hands and feet, jaundice, joint stiffness and pain in hands, elbows, and knees, and enlarged lymph nodes, along with her past medical history, suggests an autoimmune or inflammatory condition. Here are the differentials, categorized as follows:
- Single most likely diagnosis
- Systemic Lupus Erythematosus (SLE): The patient's history of photosensitive rashes, vasculitis, mild anemia, and response to prednisone, combined with her current symptoms of joint pain, jaundice, and lymphadenopathy, are all consistent with SLE. The recurrence of symptoms after a period of remission is also typical of this disease.
- Other Likely diagnoses
- Rheumatoid Arthritis (RA): The patient's symptoms of joint stiffness and pain, particularly in the hands and feet, could be indicative of RA. However, the presence of vasculitis, photosensitive rashes, and lymphadenopathy are not typical of RA.
- Sjögren's Syndrome: This autoimmune disorder can cause joint pain, fatigue, and lymphadenopathy, but it is often associated with dry eyes and mouth, which are not mentioned in the patient's history.
- Mixed Connective Tissue Disease (MCTD): This condition combines features of SLE, RA, and scleroderma, and could be considered given the patient's mix of symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma: The patient's lymphadenopathy and history of autoimmune symptoms could be indicative of lymphoma, particularly if she has a underlying immunodeficiency or chronic inflammation.
- Sepsis: The patient's fever, jaundice, and lymphadenopathy could be indicative of a severe infection, which would require prompt treatment.
- Hepatitis: The patient's jaundice and lymphadenopathy could be indicative of hepatitis, particularly if she has a history of liver disease or risk factors for hepatitis.
- Rare diagnoses
- Relapsing Polychondritis: This rare autoimmune disorder can cause joint pain, fatigue, and lymphadenopathy, but it is often associated with cartilage inflammation and destruction, which is not mentioned in the patient's history.
- Erdheim-Chester Disease: This rare condition can cause joint pain, fatigue, and lymphadenopathy, but it is often associated with bone lesions and neurological symptoms, which are not mentioned in the patient's history.