Differential Diagnosis for a 41-year-old Female with Oral Ulcers, Vaginal Pruritis, and Mildly Elevated CRP
Single Most Likely Diagnosis
- Behçet's Disease: This condition is characterized by recurrent oral ulcers, genital ulcers, and ocular inflammation. The presence of oral ulcers and vaginal pruritis (which could be indicative of genital ulcers) along with a mildly elevated CRP (indicating inflammation) makes Behçet's Disease a strong consideration.
Other Likely Diagnoses
- Systemic Lupus Erythematosus (SLE): SLE can present with a wide range of symptoms including oral ulcers, genital ulcers, and elevated inflammatory markers like CRP. The vaginal pruritis could be related to lupus-related vulvovaginitis or other autoimmune manifestations.
- Reactive Arthritis (ReA): Previously known as Reiter's syndrome, ReA can occur after certain infections and is characterized by arthritis, urethritis, and uveitis, but can also include mucocutaneous lesions like oral ulcers. Vaginal pruritis might be less common but could be part of the broader spectrum of symptoms.
- Inflammatory Bowel Disease (IBD): Both Crohn's disease and ulcerative colitis can have extraintestinal manifestations, including oral ulcers and genital lesions. The mildly elevated CRP supports an inflammatory process, which is consistent with IBD.
Do Not Miss Diagnoses
- Cancer (e.g., Squamous Cell Carcinoma): Although less likely, it's crucial not to miss a potential malignancy, especially if the oral ulcers or vaginal lesions have atypical features or do not respond to initial treatments.
- Infectious Diseases (e.g., Syphilis, HIV): Certain infectious diseases can present with oral and genital ulcers and should be considered, especially if there's a high risk of exposure or other suggestive symptoms.
- Autoimmune Disorders (e.g., Pemphigus, Vulvar Lichen Planus): These conditions can cause significant morbidity if not recognized and treated appropriately. They might present with oral and genital lesions, among other symptoms.
Rare Diagnoses
- M MAGIC Syndrome: A rare condition that overlaps with Behçet's Disease but includes additional features like aortitis and other systemic manifestations.
- Sjögren's Syndrome: An autoimmune disorder that primarily affects the exocrine glands, leading to dry mouth and eyes, but can also have extraglandular manifestations including oral ulcers and potentially vaginal dryness leading to pruritis.
- Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Some types can have mucocutaneous manifestations, though this would be a less common presentation.