Differential Diagnosis
The patient's symptoms of progressive weakness, fatigue, weight loss, and early satiety, along with a history of hypertension, coronary artery disease, and mild proteinuria, suggest a complex clinical picture. The following differential diagnoses are organized into categories:
- Single Most Likely Diagnosis
- Amyotrophic Lateral Sclerosis (ALS): The patient's progressive weakness, particularly in the hip flexors and quadriceps, and the sensation of body parts feeling 'disconnected' are suggestive of a motor neuron disease like ALS. The subacute decline in health over 4 months and significant weight loss despite increased intake also support this diagnosis.
- Other Likely Diagnoses
- Inclusion Body Myositis: This condition is characterized by progressive muscle weakness, particularly in the proximal muscles, which could explain the patient's difficulty with stair climbing and jogging.
- Lymphoma: The patient's weight loss, early satiety, and fatigue could be indicative of a malignancy like lymphoma, especially given the lack of other clear explanations for these symptoms.
- Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): This condition can cause progressive weakness and fatigue, and the patient's sensation of body parts feeling 'disconnected' could be related to neuropathy.
- Do Not Miss Diagnoses
- Spinal Cord Compression: This is a medical emergency that could cause progressive weakness, fatigue, and sensory changes. Given the patient's history of coronary artery disease and a dilated ascending thoracic aorta, spinal cord compression due to a thoracic aortic aneurysm or other vascular issue is a possibility.
- Multiple Myeloma: This malignancy can cause weight loss, fatigue, and muscle weakness, and the patient's history of hypertension and coronary artery disease may increase the risk of myeloma.
- Pituitary Adenoma: A pituitary tumor could cause fatigue, weight loss, and muscle weakness, particularly if it is affecting hormone production.
- Rare Diagnoses
- Mitochondrial Myopathies: These are a group of rare genetic disorders that affect the mitochondria and can cause progressive muscle weakness, fatigue, and other systemic symptoms.
- Pompe Disease: This is a rare genetic disorder that causes progressive muscle weakness, particularly in the proximal muscles, and can also affect the heart and other organs.
- Dermatomyositis: This is a rare inflammatory muscle disease that can cause progressive muscle weakness, fatigue, and skin rash, although the patient does not report any skin symptoms.