Differential Diagnosis for Chorea + Weight Loss + Auditory Hallucinations
Single Most Likely Diagnosis
- Huntington's Disease with Psychotic Features: This diagnosis is likely because Huntington's disease is a well-known cause of chorea, and psychiatric symptoms such as auditory hallucinations can occur, especially in the early stages. Weight loss is also common due to the disease's impact on motor function and metabolism.
Other Likely Diagnoses
- Schizophrenia with Chorea: Although less common, chorea can be a feature of schizophrenia, particularly in cases where there is a significant affective component or as a result of medication side effects. Weight loss could be due to poor self-care or medication side effects.
- Systemic Lupus Erythematosus (SLE) with Neuropsychiatric Manifestations: SLE can cause a wide range of neurological and psychiatric symptoms, including chorea and auditory hallucinations. Weight loss is also a common symptom due to the systemic nature of the disease.
- Hyperthyroidism with Chorea and Psychiatric Symptoms: Hyperthyroidism can cause weight loss, chorea, and psychiatric symptoms including hallucinations. Although less common, this diagnosis should be considered due to the potential for significant morbidity if left untreated.
Do Not Miss Diagnoses
- Neurosyphilis: This condition can cause a wide range of neurological and psychiatric symptoms, including chorea and hallucinations. Weight loss can occur due to systemic illness. Neurosyphilis is a diagnosis that must not be missed due to its treatability with antibiotics.
- Creutzfeldt-Jakob Disease: Although rare, this prion disease can cause rapid neurological deterioration, including chorea, psychiatric symptoms, and significant weight loss. It is essential to consider this diagnosis due to its fatal outcome and the need for prompt isolation to prevent transmission.
- Wilson's Disease: This genetic disorder can cause liver disease, neurological symptoms including chorea, and psychiatric symptoms. Weight loss can occur due to liver dysfunction. Wilson's disease is treatable, but failure to diagnose it can lead to severe morbidity and mortality.
Rare Diagnoses
- Chorea-Acanthocytosis: A rare genetic disorder characterized by chorea, self-mutilating behaviors, and acanthocytosis (abnormal red blood cells). Weight loss and psychiatric symptoms can occur, but this diagnosis is much less likely due to its rarity.
- Pantothenate Kinase-Associated Neurodegeneration (PKAN): A rare genetic disorder causing progressive neurological deterioration, including chorea. Psychiatric symptoms and weight loss can be part of the clinical presentation, but this diagnosis is rare and usually associated with other specific neurological findings.