Differential Diagnosis for a 28-year-old with Recurrent Hives and Esophagitis
Single Most Likely Diagnosis
- Eosinophilic Esophagitis (EoE): This condition is characterized by recurrent hives (which could be related to atopic conditions) and esophagitis, often associated with eosinophilia. The presence of both symptoms in a young adult makes EoE a strong consideration, especially given its association with atopic diseases like asthma and eczema.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): While GERD primarily causes heartburn and regurgitation, it can lead to esophagitis. If the patient has atopic conditions leading to hives, GERD could be a coincidental finding or contribute to the esophagitis.
- Food Allergies or Intolerances: These can cause both hives (as an allergic reaction) and esophagitis (through an immune response or irritation). Common culprits include nuts, shellfish, milk, eggs, wheat, and soy.
- Infections (e.g., HSV, CMV): Certain viral infections can cause esophagitis, and if the patient has a compromised immune system or is immunocompromised, these should be considered. Hives could be a systemic response to the infection.
Do Not Miss Diagnoses
- Herpes Simplex Virus (HSV) Esophagitis: Although less common, HSV esophagitis can be severe and requires antiviral treatment. It might not directly cause hives but could be part of a broader systemic infection.
- Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome): A rare autoimmune condition that can cause both skin manifestations (like hives) and gastrointestinal symptoms, including esophagitis. It's crucial to consider due to its potential severity and need for immunosuppressive treatment.
- Acute HIV Infection: The acute retroviral syndrome can present with a wide range of symptoms, including rash (which might resemble hives) and esophagitis due to opportunistic infections.
Rare Diagnoses
- Mastocytosis: A condition characterized by the accumulation of mast cells in one or more organs. It can cause hives and gastrointestinal symptoms, including esophagitis, due to mast cell degranulation.
- Systemic Mastocytosis with Associated Hematologic Neoplasm: A rare condition where mastocytosis occurs alongside another hematologic disorder, potentially causing a wide range of symptoms including hives and esophagitis.
- Autoimmune Disorders (e.g., Lupus, Sjögren's Syndrome): These can cause a variety of symptoms, including skin rashes and gastrointestinal issues, though esophagitis would be less common.