Differential Diagnosis
- Single most likely diagnosis
- F) Somatic symptom disorder: This diagnosis is the most likely because the patient presents with multiple, recurring physical symptoms (weakness, generalized malaise, burning sensation in her eyes, and frequent headaches) that have been thoroughly evaluated with no underlying medical condition found. Her preoccupation with these symptoms and the absence of any abnormal findings on physical examination and laboratory studies support this diagnosis.
- Other Likely diagnoses
- C) Illness anxiety disorder (hypochondriasis): This could be considered if the patient's primary concern was the fear of having a specific disease rather than the symptoms themselves. However, the description provided leans more towards a preoccupation with the symptoms rather than a fear of a specific illness.
- B) Fibromyalgia: Although fibromyalgia could explain some of the patient's symptoms like widespread pain and fatigue, the absence of specific tender points and the broad range of symptoms (including gastrointestinal, neurologic, and rheumatologic) make it less likely compared to somatic symptom disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- A) Carcinoid tumor: Although rare and less likely given the normal evaluations, carcinoid tumors can present with a variety of systemic symptoms due to the secretion of various substances. Missing this diagnosis could have significant implications.
- D) Multiple sclerosis: This is an important diagnosis not to miss due to its potential for significant neurological impairment. However, the lack of specific neurological findings and the normal MRI of the brain make it less likely.
- G) Systemic lupus erythematosus: SLE can present with a wide range of symptoms affecting multiple systems, and missing this diagnosis could lead to serious complications. The normal laboratory studies and lack of specific findings on physical examination make it less likely.
- Rare diagnoses
- E) Rheumatoid arthritis: While it's possible for rheumatoid arthritis to present with systemic symptoms, the lack of specific joint findings and the normal laboratory studies (which would typically include inflammatory markers and possibly rheumatoid factor) make this a less likely diagnosis in this context.
- Other rare diagnoses could include conditions like porphyria or mitochondrial disorders, which can present with a wide range of systemic symptoms. However, these would be considered very unlikely without more specific findings or a suggestive family history.