Differential Diagnosis for 65 YOF with Swollen Neck, Red Eyes, and Tongue Swelling
- Single Most Likely Diagnosis
- Metronidazole-induced angioedema or allergic reaction: The patient started metronidazole 4 days ago, and the symptoms of swollen neck, red eyes, and tongue swelling are consistent with an allergic reaction or angioedema, which can be a side effect of metronidazole.
- Other Likely Diagnoses
- Rheumatoid arthritis flare: The patient has a history of rheumatoid arthritis, and the symptoms could be related to a flare of the disease, although the specific symptoms of red eyes and tongue swelling are less typical.
- Infection: The patient was being treated for bacterial vaginosis, and although metronidazole is effective, the symptoms could be related to a spread of the infection or a new infection.
- Do Not Miss Diagnoses
- Angioedema due to other causes (e.g., ACE inhibitor use, hereditary angioedema): These conditions can cause similar symptoms and are life-threatening if not recognized and treated promptly.
- Anaphylaxis: Although the patient's symptoms do not fully meet the criteria for anaphylaxis, it is essential to consider this diagnosis, as it is a medical emergency.
- Rare Diagnoses
- Sjögren's syndrome: This autoimmune disorder can cause dry eyes and mouth, but it is less likely to cause acute tongue swelling and neck swelling.
- Stevens-Johnson syndrome or toxic epidermal necrolysis: These rare skin conditions can cause similar symptoms, but they are usually associated with more widespread skin lesions and are often related to medication use, including antibiotics like metronidazole.
- Giant cell arteritis: This condition can cause neck swelling and eye symptoms, but it is less likely to cause tongue swelling, and the patient's age and symptoms do not fully align with this diagnosis.