Differential Diagnosis for 17-year-old with Chest Pain and Elevated Immunoglobulin E
Single Most Likely Diagnosis
- Asthma: The patient's symptoms of chest pain and difficulty breathing, combined with elevated Immunoglobulin E (IgE) levels, suggest an allergic or atopic condition. Asthma is a common condition in adolescents that can cause these symptoms, and elevated IgE levels are often seen in allergic asthma.
Other Likely Diagnoses
- Allergic Bronchopulmonary Aspergillosis (ABPA): This condition is characterized by an allergic reaction to Aspergillus fungus, which can cause chest pain, difficulty breathing, and elevated IgE levels. The patient's symptoms and lab results make this a plausible diagnosis.
- Chronic Urticaria: Although the patient's primary complaint is chest pain and difficulty breathing, chronic urticaria can cause chest tightness and difficulty breathing in some cases. Elevated IgE levels are often seen in chronic urticaria.
- Atopic Dermatitis: While atopic dermatitis primarily affects the skin, it can be associated with elevated IgE levels and may contribute to the patient's symptoms.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although the patient's symptoms and lab results suggest an allergic or atopic condition, pulmonary embolism is a life-threatening condition that can cause chest pain and difficulty breathing. It is essential to consider this diagnosis, even if it seems unlikely.
- Cardiac Conditions (e.g., Hypertrophic Cardiomyopathy): Cardiac conditions can cause chest pain and difficulty breathing, and some conditions, such as hypertrophic cardiomyopathy, can be asymptomatic until a catastrophic event occurs.
Rare Diagnoses
- Hyper-IgE Syndrome (Job Syndrome): This rare condition is characterized by recurrent cutaneous and pulmonary infections, elevated IgE levels, and eczema. While the patient's symptoms do not entirely fit this diagnosis, it is a rare condition that could be considered.
- Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome): This rare autoimmune condition can cause asthma, elevated IgE levels, and systemic symptoms. However, the patient's lack of systemic symptoms and normal RA factor and ANA panel make this diagnosis less likely.