Differential Diagnosis for Fatigue, Nausea, Pallor, and Glossitis in a Vegan
Single Most Likely Diagnosis
- Iron Deficiency Anemia: This is the most likely diagnosis due to the patient's vegan diet, which can be low in iron if not properly planned. Iron deficiency anemia can cause fatigue, pallor, and glossitis (inflammation of the tongue), and nausea can be associated with the underlying cause of the anemia or its treatment.
Other Likely Diagnoses
- Vitamin B12 Deficiency: Similar to iron, vitamin B12 is found primarily in animal products, making vegans at risk for deficiency if they don't consume fortified foods or supplements. Vitamin B12 deficiency can lead to fatigue, pallor, glossitis, and nausea.
- Folate Deficiency: Although folate is found in leafy greens, a diet lacking variety or with inadequate intake can lead to deficiency. Folate deficiency can cause similar symptoms to vitamin B12 deficiency, including fatigue, pallor, and glossitis.
- Zinc Deficiency: Zinc is an essential mineral that can be low in vegan diets if not properly planned. Zinc deficiency can lead to impaired taste and smell, wound healing issues, and potentially contribute to fatigue and nausea.
Do Not Miss Diagnoses
- Celiac Disease: An autoimmune disorder that can cause malabsorption of essential nutrients, including iron, vitamin B12, and folate, leading to the symptoms described. It's crucial to diagnose celiac disease as it requires a strict gluten-free diet to manage.
- Gastritis or Peptic Ulcer Disease: Conditions that can cause nausea and potentially lead to iron deficiency anemia due to chronic blood loss. They are important to diagnose as they may require specific treatment to prevent complications.
- Hypothyroidism: Although less directly related to diet, hypothyroidism can cause fatigue, nausea, and potentially contribute to iron deficiency anemia. It's a condition that significantly impacts quality of life and requires medical treatment.
Rare Diagnoses
- Pernicious Anemia: An autoimmune condition leading to vitamin B12 deficiency due to the lack of intrinsic factor, necessary for B12 absorption. It's rare but important to diagnose as it requires lifelong vitamin B12 supplementation.
- Sjögren's Syndrome: An autoimmune disorder that can cause glossitis among other symptoms, though it's less directly linked to the dietary habits described.
- Chronic Lead Poisoning: Can cause fatigue, pallor, and gastrointestinal symptoms like nausea. Although rare, especially in adults without specific exposure risks, it's a diagnosis that should not be missed due to its serious health implications.