Differential Diagnosis for a 38-year-old Female with Cyclical Canker Sores, Viral-like Illness, and Symptoms Coinciding with Menses

• Single Most Likely Diagnosis:
  • Pre-Menstrual Syndrome (PMS) with associated oral manifestations (canker sores) and viral-like symptoms. This diagnosis is likely due to the cyclical nature of symptoms coinciding with the menstrual cycle, which is a hallmark of PMS. The symptoms of sore throat, body aches, and canker sores can be associated with the hormonal fluctuations seen in PMS.
• Other Likely Diagnoses:
  • Recurrent Aphthous Stomatitis (RAS): This condition is characterized by recurring canker sores and can be exacerbated by hormonal changes, stress, and certain foods. The cyclical pattern could suggest a link with menstrual cycles.
  • Systemic Lupus Erythematosus (SLE): Although less common, SLE can present with a variety of symptoms including oral ulcers, sore throat, and body aches, and can have a cyclical pattern due to hormonal influences.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can have extraintestinal manifestations including oral ulcers and may have symptoms that worsen with the menstrual cycle.
• Do Not Miss Diagnoses:
  • Behçet's Disease: A rare condition characterized by recurrent oral ulcers, genital ulcers, and ocular inflammation. It's crucial not to miss this diagnosis due to its potential for serious complications, including blindness and vascular complications.
  • HIV Infection: Oral ulcers and recurrent infections can be a sign of immunocompromised states such as HIV. Early diagnosis is critical for treatment and prevention of complications.
  • Cancer (e.g., Leukemia): Certain types of cancer can present with recurrent infections, oral ulcers, and systemic symptoms like body aches. Although rare, missing a diagnosis of cancer can have devastating consequences.
• Rare Diagnoses:
  • Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) Syndrome: A rare condition characterized by periodic episodes of fever, aphthous stomatitis, pharyngitis, and adenitis. It's more common in children but can occur in adults.
  • Autoinflammatory Disorders: Conditions like Familial Mediterranean Fever can present with periodic fever and other systemic symptoms, including oral ulcers, though these are rare and typically present in specific ethnic groups.