Differential Diagnosis for 82-year-old Female with Body Aches, Back Pain, and Bilateral Eye Pain
Single most likely diagnosis:
- Giant Cell Arteritis (GCA): This condition is a strong consideration given the patient's age, symptoms of bilateral eye pain, and the presence of systemic symptoms like body aches and back pain. The worsening and improvement of symptoms, as well as the lack of response to Tylenol, also align with GCA, which often requires steroid treatment.
Other Likely diagnoses:
- Polymyalgia Rheumatica (PMR): Similar to GCA, PMR is an inflammatory condition that affects older adults, causing muscle pain and stiffness, particularly in the shoulders and hips. The back pain and body aches could be consistent with PMR, although the bilateral eye pain is more suggestive of GCA.
- Hypertension-related symptoms: Given the patient's high blood pressure (180/92), it's possible that some of her symptoms could be related to hypertension, although this would not typically cause bilateral eye pain.
- Osteoarthritis or other degenerative joint diseases: These conditions could explain the back pain and body aches but would not typically cause bilateral eye pain.
Do Not Miss diagnoses:
- Temporal Arteritis with impending visual loss: A variant of GCA that specifically affects the temporal arteries and can lead to sudden, permanent vision loss if not promptly treated.
- Malignancy (e.g., multiple myeloma, metastatic cancer): Although less likely, certain cancers can cause widespread pain, including back pain and body aches, and it's crucial not to miss these diagnoses due to their severe implications.
- Infections (e.g., endocarditis, osteomyelitis): Infections can cause systemic symptoms and pain, and in an elderly patient, these conditions can be life-threatening if not diagnosed and treated promptly.
Rare diagnoses:
- Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation in various parts of the body, including the eyes, and could potentially explain some of the patient's symptoms.
- Sarcoidosis: A condition that can cause inflammation in various organs, including the eyes, and might result in some of the symptoms described, although it would be less common in this age group and presentation.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can affect various parts of the body, including the eyes, but would typically present with additional symptoms such as respiratory issues.