Differential Diagnosis

• Single most likely diagnosis:
  • Inflammatory Bowel Disease (IBD) with associated vasculopathy: The patient's history of itchy skin disease, nail changes, and the development of abdominal pain with thrombosis in multiple arteries, followed by symptoms of loose stools and vomiting with wall thickening of ileal loops and stricture on CECT, points towards an underlying inflammatory condition such as Crohn's disease, which is a type of IBD. The vasculopathy could be related to the IBD or a separate entity like vasculitis, but the presence of skin and nail changes along with gastrointestinal symptoms makes IBD a strong consideration.
• Other Likely diagnoses:
  • Vasculitis (e.g., Giant Cell Arteritis, Polyarteritis Nodosa): The patient's presentation with thrombosis in multiple arteries and wall thickening in the aorta, along with the development of gastrointestinal symptoms, could suggest a systemic vasculitis. However, the absence of other typical symptoms such as fever, weight loss, or specific organ involvement (e.g., renal, neurological) makes this less likely than IBD.
  • Thromboangiitis Obliterans (Buerger's Disease): This condition involves inflammation and thrombosis of blood vessels and could explain the patient's arterial thromboses. However, it typically affects smaller and medium-sized arteries and is strongly associated with smoking, which is not mentioned in the patient's history.
• Do Not Miss diagnoses:
  • Malignancy (e.g., lymphoma, adenocarcinoma): Although less likely, malignancy could cause both thrombosis (Trousseau’s syndrome) and gastrointestinal symptoms. It's crucial to rule out cancer due to its significant implications for treatment and prognosis.
  • Infectious causes (e.g., diverticulitis, infectious colitis): Infections could lead to the patient's gastrointestinal symptoms and potentially to thrombosis in the setting of severe sepsis. However, the chronic nature of the patient's symptoms and the absence of fever or leukocytosis make this less likely.
• Rare diagnoses:
  • Ehlers-Danlos Syndrome: A genetic disorder that affects connective tissue and could lead to vascular fragility and thrombosis. The patient's nail changes and skin disease might be related, but this diagnosis would not fully explain the gastrointestinal symptoms without other supporting features.
  • Sneddon's Syndrome: A rare condition characterized by livedo reticularis and cerebral vasculopathy, which could potentially explain some of the patient's vascular findings. However, it does not typically present with gastrointestinal symptoms or the specific pattern of thrombosis seen in this patient.