Differential Diagnosis for 30-year-old Male with Nausea, Diarrhea, and Dizziness
- Single most likely diagnosis:
- Cymbalta (Duloxetine) withdrawal syndrome: The patient stopped taking Cymbalta, which he was prescribed for chronic back pain, 2 weeks ago due to side effects. The symptoms of nausea, diarrhea, abdominal cramping, and dizziness are consistent with withdrawal from this medication, especially given the temporal relationship between stopping the medication and the onset of symptoms.
- Other Likely diagnoses:
- Viral gastroenteritis: The patient's symptoms of nausea, diarrhea, and abdominal cramping could be indicative of a viral gastrointestinal infection, especially considering the improvement and then recurrence of symptoms after eating fast food.
- Food poisoning: The recurrence of diarrhea and abdominal cramping after eating fast food suggests the possibility of food poisoning, which could be caused by consuming contaminated or spoiled food.
- Anxiety or panic disorder exacerbation: Given the patient's history of severe anxiety and depression, it's possible that his symptoms could be exacerbated by or related to an anxiety or panic disorder, particularly with the description of an intermittent "woozy sensation" and dizziness.
- Do Not Miss diagnoses:
- Inflammatory bowel disease (IBD) flare: Although less likely, it's crucial not to miss a potential flare of IBD, such as Crohn's disease or ulcerative colitis, which could present with similar gastrointestinal symptoms.
- Neurological disorders (e.g., multiple sclerosis, vestibular disorders): The patient's complaint of dizziness, especially described as a "woozy sensation" with changing positions, warrants consideration of neurological causes, although these would be less common.
- Adverse reaction to food or other substances: An adverse reaction to something in the fast food or another substance could cause similar symptoms and should be considered.
- Rare diagnoses:
- Autoimmune disorders (e.g., postural orthostatic tachycardia syndrome - POTS): Rare autoimmune disorders could potentially explain some of the patient's symptoms, such as the dizziness with positional changes.
- Endocrine disorders (e.g., adrenal insufficiency): Although rare, endocrine disorders could present with non-specific symptoms like nausea, diarrhea, and dizziness, making them important to consider in a differential diagnosis.