Differential Diagnosis
- Single Most Likely Diagnosis
- Vitamin B12 deficiency: The patient has a known history of B12 deficiency, which was last checked 3 years ago. Given her history of sleeve gastrectomy, she is at high risk for malabsorption of vitamins, including B12. A deficiency in B12 can cause fatigue, weakness, and neurological symptoms, which align with her complaint of a complete lack of energy.
- Other Likely Diagnoses
- Iron deficiency anemia: The patient has a history of two caesarians and one miscarriage, which can lead to iron deficiency anemia. Additionally, her sleeve gastrectomy may have affected her iron absorption. Iron deficiency anemia can cause fatigue, weakness, and shortness of breath.
- Depression: The patient has a long history of anxiety and depression, and her current complaint of not recognizing herself may indicate a relapse or worsening of her mental health condition.
- Hypothyroidism: The patient's complaint of fatigue and lack of energy could be indicative of hypothyroidism, particularly given her history of sleeve gastrectomy, which may affect thyroid hormone levels.
- Do Not Miss Diagnoses
- Pulmonary embolism: Although the patient does not have any obvious symptoms of pulmonary embolism, her history of heterozygote Leyden mutation (a thrombophilic condition) and two caesarians increases her risk for venous thromboembolism. Fatigue and shortness of breath can be subtle symptoms of pulmonary embolism.
- Spinal cord compression: The patient's underlying spinal pathology, including a herniated lumbar disc with nerve contact bilaterally, increases her risk for spinal cord compression. This condition can cause fatigue, weakness, and neurological symptoms, and requires prompt medical attention.
- Rare Diagnoses
- Pernicious anemia: This is a rare autoimmune disorder that causes the body to produce antibodies against intrinsic factor, leading to vitamin B12 deficiency. Although the patient has a known history of B12 deficiency, pernicious anemia is a rare condition that should be considered if other causes of B12 deficiency are ruled out.
- Adrenal insufficiency: This is a rare condition that can cause fatigue, weakness, and weight loss. Although the patient's symptoms are non-specific, adrenal insufficiency should be considered if other causes of her symptoms are ruled out.