Differential Diagnosis for Patient with Grade 3 Blood Pressure, Breathlessness, Night Sweats, and Fatigue

• Single Most Likely Diagnosis
  • Hypertensive Heart Disease: This condition is likely given the patient's grade 3 blood pressure, which can lead to heart failure, explaining the breathlessness and fatigue. Night sweats can be associated with the stress of uncontrolled hypertension on the body.
• Other Likely Diagnoses
  • Chronic Kidney Disease (CKD): Uncontrolled high blood pressure can lead to CKD, which in turn can cause fatigue, breathlessness due to anemia or fluid overload, and night sweats due to electrolyte imbalances or anemia.
  • Heart Failure: Directly related to uncontrolled hypertension, heart failure can cause all the symptoms presented, including breathlessness (due to pulmonary congestion), fatigue, and night sweats (possibly due to decreased cardiac output and subsequent sympathetic nervous system activation).
  • Sleep Apnea: Often associated with hypertension, sleep apnea can cause fatigue and breathlessness. Night sweats can occur due to the stress response during apneic episodes.
• Do Not Miss Diagnoses
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension, along with symptoms like night sweats, fatigue, and breathlessness due to catecholamine excess.
  • Tuberculosis (TB): Although less common in some regions, TB can cause night sweats, fatigue, and breathlessness. Hypertension might not be directly related but could be coincidental or due to another underlying condition.
  • Lymphoma: Certain types of lymphoma can cause systemic symptoms like night sweats, fatigue, and unexplained weight loss. Breathlessness could be due to a large mediastinal mass or pleural effusion.
• Rare Diagnoses
  • Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, including the heart, which can lead to restrictive cardiomyopathy, heart failure, and subsequently the symptoms described.
  • Multiple Myeloma: A plasma cell disorder that can cause fatigue, night sweats, and renal failure leading to hypertension. Breathlessness could be due to anemia or pulmonary involvement.
  • Thyrotoxicosis: Although typically presents with weight loss, exophthalmos, and tremors, thyrotoxicosis can also cause hypertension, fatigue, breathlessness, and night sweats due to the hypermetabolic state.