Differential Diagnosis
- Single most likely diagnosis
- Rheumatoid arthritis (RA) with methotrexate-induced lung disease or RA-associated interstitial lung disease (ILD): The patient has a history of RA, and the development of dyspnea, dry cough, and interstitial markings on chest radiography could be indicative of methotrexate-induced lung disease or RA-associated ILD.
- Other Likely diagnoses
- Systemic lupus erythematosus (SLE): The patient's son has SLE, and she has developed some symptoms that could be suggestive of SLE, such as dyspnea, pleural effusions, and pericardial effusion.
- Sjögren's syndrome: The patient's symptoms of dry mouth and dry eyes could be indicative of Sjögren's syndrome, which is often associated with RA.
- Pericarditis: The patient has pericardial effusion and thickening, which could be indicative of pericarditis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cardiac tamponade: The patient has a pericardial effusion, which could potentially lead to cardiac tamponade, a life-threatening condition.
- Pulmonary embolism: The patient has dyspnea and pleural effusions, which could be indicative of a pulmonary embolism.
- Malignancy: The patient has a history of a solitary lung nodule, and the development of dyspnea and pleural effusions could be indicative of a malignancy.
- Rare diagnoses
- Erdheim-Chester disease: The patient has pericardial and pleural effusions, as well as soft-tissue thickening surrounding the aorta, which could be indicative of Erdheim-Chester disease, a rare form of histiocytosis.
- IgG4-related disease: The patient has pericardial and pleural effusions, as well as soft-tissue thickening surrounding the aorta, which could be indicative of IgG4-related disease, a rare autoimmune disorder.
- Sarcoidosis: The patient has dyspnea, pleural effusions, and pericardial effusion, which could be indicative of sarcoidosis, a rare autoimmune disorder.