Differential Diagnosis

The patient's presentation is complex, with a combination of symptoms and laboratory findings that suggest multiple potential diagnoses. Here's a breakdown of the differential diagnosis into the specified categories:

• Single Most Likely Diagnosis

  • Sepsis: The patient has an elevated white blood cell count (WBC), increased lactic acid levels, and an elevated procalcitonin level, all of which are indicative of a severe infection. The presence of a sore throat could be the source of the infection. The elevated BNP and troponin levels could be due to the systemic effects of sepsis on the heart, even in the absence of cardiac issues.

• Other Likely Diagnoses

  • Pulmonary Embolism: Although the patient does not have chest pain, the elevated BNP and troponin levels, along with increased edema, could suggest a pulmonary embolism. The lack of chest pain does not rule out this diagnosis, as some patients may present atypically.
  • Heart Failure: The elevated BNP level is highly suggestive of heart failure, and the troponin elevation could indicate myocardial stress or injury secondary to heart failure. The absence of cardiac issues in the patient's history does not preclude the development of new-onset heart failure.
  • Myocarditis: This condition, which is an inflammation of the heart muscle, could explain the elevated troponin levels. Myocarditis can be caused by viral infections, and the patient's sore throat could be a clue to a viral etiology.

• Do Not Miss Diagnoses

  • Acute Coronary Syndrome (ACS): Although the patient has no chest pain and a normal EKG, it is crucial not to miss ACS, especially given the elevated troponin levels. Atypical presentations of ACS can occur, particularly in older adults.
  • Aortic Dissection: This is a life-threatening condition that can present with a variety of symptoms, including those unrelated to chest pain. The elevated troponin and BNP levels could be seen in aortic dissection due to involvement of the aortic root or compression of the coronary arteries.

• Rare Diagnoses

  • Stress Cardiomyopathy (Takotsubo Cardiomyopathy): This condition can mimic acute coronary syndrome and heart failure, with elevated troponin levels. It is often precipitated by intense emotional or physical stress.
  • Cardiac Sarcoidosis: This rare condition can cause heart failure and elevated troponin levels due to inflammation of the heart muscle. It might be considered if other diagnoses are ruled out and there are suggestive findings on imaging or biopsy.