Differential Diagnosis

The patient's symptoms of bilateral hearing loss, blurry vision, constant nasal drainage, fatigue, positive ANA, joint swelling, and muscle pain suggest a complex autoimmune or inflammatory condition. Here's a categorized differential diagnosis:

• Single most likely diagnosis

  • Systemic Lupus Erythematosus (SLE): This condition is a strong candidate given the positive ANA, joint swelling, muscle pain, and the constellation of other symptoms that can be associated with SLE, including hearing loss and vision problems. SLE is known for its diverse presentations and can affect multiple organ systems.

• Other Likely diagnoses

  • Relapsing Polychondritis: This rare autoimmune disorder can cause cartilage inflammation, leading to symptoms like nasal drainage, hearing loss, and vision problems due to its effects on the eyes and ears. The presence of joint swelling and muscle pain also aligns with this diagnosis.
  • Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): This condition is characterized by inflammation of the blood vessels and can affect various organs, including the ears, eyes, and respiratory tract, leading to symptoms like hearing loss, vision problems, and nasal drainage.
  • Sjögren's Syndrome: An autoimmune disorder that primarily affects the glands that produce tears and saliva, but it can also cause systemic symptoms including joint pain, muscle pain, and potentially hearing loss and vision issues, especially if there's associated inflammation.

• Do Not Miss diagnoses

  • Vasculitis (e.g., Giant Cell Arteritis): Although less likely given the patient's age and the breadth of symptoms, vasculitis can cause a wide range of systemic symptoms including vision loss, hearing loss, and systemic inflammation. Missing this diagnosis could lead to severe complications, including blindness.
  • Sarcoidosis: This condition can affect multiple organ systems and present with a variety of symptoms, including joint pain, muscle pain, vision problems, and potentially hearing loss. It's crucial not to miss sarcoidosis due to its potential for serious complications if left untreated.

• Rare diagnoses

  • Cogan Syndrome: A rare disorder characterized by recurrent corneal inflammation and vestibular-auditory symptoms, which could explain the hearing loss and vision problems. It's often associated with systemic vasculitis.
  • Autoimmune Inner Ear Disease (AIED): Although it primarily affects the inner ear, leading to hearing loss, some patients may experience systemic symptoms that could overlap with those described. It's a diagnosis to consider, especially if other explanations for the systemic symptoms are ruled out.