Differential Diagnosis for 61 yo with Subacute Diarrhea, Nausea, Vomiting, Skin Vasculitis, Progressive Lower and Upper Extremity Weakness, Confusion, Lethargy, and Mesenteric Adenitis

• Single Most Likely Diagnosis
  • Eosinophilic Gastroenteritis with Systemic Involvement: This condition is characterized by eosinophilic infiltration of the gastrointestinal tract, which can lead to diarrhea, nausea, vomiting, and abdominal pain. The presence of skin vasculitis, progressive weakness, confusion, and lethargy suggests systemic involvement, including potential neurological and muscular manifestations. Mesenteric adenitis could be part of the systemic eosinophilic infiltration.
• Other Likely Diagnoses
  • Systemic Lupus Erythematosus (SLE): SLE can present with a wide range of symptoms including gastrointestinal issues (like diarrhea and nausea), skin vasculitis, and neurological symptoms (such as confusion and lethargy). The progressive weakness could be due to musculoskeletal involvement.
  • Polyarteritis Nodosa (PAN): This is a systemic vasculitis that can affect multiple organ systems, leading to symptoms like skin vasculitis, gastrointestinal issues (including mesenteric adenitis), and neurological symptoms due to vasculitis affecting various parts of the body.
  • Gastrointestinal Lymphoma: Lymphoma involving the gastrointestinal tract can cause diarrhea, nausea, vomiting, and mesenteric adenitis. Systemic symptoms like progressive weakness, confusion, and lethargy could be due to lymphoma spread or paraneoplastic syndromes.
• Do Not Miss Diagnoses
  • Neurosyphilis: Although less common, neurosyphilis can present with a wide range of neurological symptoms including confusion, lethargy, and progressive weakness. Gastrointestinal symptoms and skin manifestations can also occur in syphilis.
  • Vasculitic Syndromes (e.g., Wegener's Granulomatosis, Microscopic Polyangiitis): These conditions can cause a combination of gastrointestinal, neurological, and skin symptoms due to vasculitis. They are less common but critical to diagnose due to their potential for severe organ damage.
  • Infectious Causes (e.g., Lyme Disease, Neurocysticercosis): Certain infections can cause a combination of gastrointestinal, neurological, and skin symptoms. While less likely, they are crucial to consider due to the potential for specific treatments.
• Rare Diagnoses
  • Ehlers-Danlos Syndrome with Gastrointestinal and Neurological Involvement: This genetic disorder can lead to gastrointestinal symptoms, skin manifestations, and potentially neurological issues due to tissue fragility and vascular complications.
  • Mitochondrial Myopathies with Gastrointestinal Involvement: Certain mitochondrial disorders can cause progressive weakness, gastrointestinal symptoms, and neurological issues, though they are rare and typically have a more chronic course.
  • Paraneoplastic Syndromes: These are rare conditions triggered by an immune response to a cancer, which can cause a wide range of symptoms including gastrointestinal issues, skin vasculitis, and neurological symptoms.