Differential Diagnosis

The patient's presentation of acute onset of profuse sweating, inability to cool down, dry cough, and significant anxiety, along with her medical history, suggests a range of potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Anxiety Attack or Panic Disorder: Given the patient's history of bipolar disorder and significant anxiety related to her health, particularly her prior pulmonary embolism, an anxiety attack or panic disorder is a plausible explanation for her symptoms. The symptoms of profuse sweating, facial flushing, and drenching perspiration can be associated with severe anxiety.

• Other Likely Diagnoses

  • Pulmonary Embolism (PE): Although the patient denies chest pain, a recurrent pulmonary embolism should be considered, especially given her history. The dry cough could be a symptom of a PE, and anxiety can be both a cause and a result of a PE.
  • Medication Side Effects (Eliquis or Omeprazole): While less common, certain medications can cause sweating and flushing as side effects. Eliquis (apixaban) and omeprazole could potentially contribute to these symptoms, although they are not the most common side effects.
  • Hypertension or Cardiovascular Event: The symptoms of sweating and flushing could also be indicative of a cardiovascular event or uncontrolled hypertension, which would need to be promptly evaluated.

• Do Not Miss Diagnoses

  • Pulmonary Hypertension: This condition can present with symptoms similar to those of a pulmonary embolism and can be a complication of recurrent PEs. It's crucial to consider this diagnosis given the patient's history.
  • Cardiac Tamponade or Other Cardiac Emergencies: Although less likely, these conditions can present with anxiety, sweating, and potentially a dry cough if there's associated pulmonary congestion. They are life-threatening and require immediate diagnosis and treatment.
  • Thyroid Storm: This is a life-threatening condition that requires immediate attention. Symptoms can include excessive sweating, anxiety, and heat intolerance, among others.

• Rare Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of sweating, flushing, and hypertension. Given the patient's symptoms, although rare, it should be considered in the differential diagnosis.
  • Carcinoid Syndrome: This condition, caused by a neuroendocrine tumor, can lead to flushing and sweating among other symptoms. It's rare but should be considered if other diagnoses are ruled out.

Labs and Tests

To evaluate these potential diagnoses, the following labs and tests could be ordered:

• D-dimer (to rule out pulmonary embolism, though its utility may be limited in patients with a history of PE)
• Troponin and ECG (to evaluate for cardiac injury or ischemia)
• Complete Blood Count (CBC), basic metabolic panel (BMP), and liver function tests (LFTs) to assess for any underlying infection, electrolyte imbalance, or liver dysfunction
• Thyroid function tests (TFTs) to rule out thyroid storm or other thyroid disorders
• Blood pressure monitoring to assess for hypertension
• Consider chest CT or ventilation-perfusion scan if pulmonary embolism is suspected and cannot be ruled out by other means
• Echocardiogram to evaluate cardiac function and rule out pulmonary hypertension or cardiac tamponade
• 24-hour urine metanephrines or plasma free metanephrines to screen for pheochromocytoma if suspected

Each of these tests and labs is aimed at narrowing down the differential diagnosis based on the patient's presentation and medical history.