Differential Diagnosis for Severe Facial Pain and Polyarthralgias with Positive IgM for EBV
- Single most likely diagnosis:
- Multiple Sclerosis (MS) or Neuromyelitis Optica (NMO) with a coincidental EBV infection: The severe, intense facial pain could be indicative of Trigeminal Neuralgia, which is sometimes associated with MS. The positive IgM for EBV might be a coincidental finding, as many people are infected with EBV at some point in their lives.
- Other Likely diagnoses:
- Rheumatoid Arthritis (RA) with a coincidental EBV infection: Polyarthralgias are a common symptom of RA, and the positive IgM for EBV could be an unrelated finding.
- Lyme Disease: This condition can cause facial pain, arthralgias, and has been associated with EBV reactivation.
- Sjögren's Syndrome: This autoimmune disorder can cause polyarthralgias and may be associated with EBV infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Temporal Arteritis or Giant Cell Arteritis: Although less likely, these conditions can cause severe facial pain and are medical emergencies that require prompt treatment to prevent vision loss.
- Central Nervous System (CNS) Lymphoma: EBV is associated with an increased risk of CNS lymphoma, which can cause a variety of neurological symptoms, including facial pain.
- Rare diagnoses:
- EBV-associated Hemophagocytic Lymphohistiocytosis (HLH): A rare, life-threatening condition that can cause a range of symptoms, including fever, rash, and neurological abnormalities.
- Chronic Active EBV Infection: A rare condition characterized by persistent EBV infection, which can cause a range of symptoms, including fever, fatigue, and lymphadenopathy.