Differential Diagnosis
- Single most likely diagnosis
- Uremic Pericarditis: The patient has a history of chronic kidney disease (CKD) with a creatinine level of 2.1, which increases the risk of uremic pericarditis. The presentation of pleuritic chest pain, low-grade fever, and new murmur, along with the elevated inflammatory markers (ESR 74, CRP 2.99), supports this diagnosis. The patient's symptoms and lab results are consistent with uremic pericarditis, which is a known complication of CKD.
- Other Likely diagnoses
- Viral Pericarditis: The patient's symptoms of pleuritic chest pain, low-grade fever, and new murmur, along with the elevated inflammatory markers, could also be consistent with viral pericarditis. However, the absence of a clear viral infection history and the presence of CKD make uremic pericarditis more likely.
- Bacterial Pericarditis: Although less likely, bacterial pericarditis is a possibility, especially given the patient's elevated WBC count (21). However, the absence of a clear source of infection and the patient's chronic steroid use for eosinophilic pneumonia make this diagnosis less likely.
- Autoimmune Pericarditis: The patient's history of chronic steroid use for eosinophilic pneumonia and the presence of elevated inflammatory markers could suggest an autoimmune component to the pericarditis. However, this diagnosis is less likely than uremic pericarditis given the patient's CKD.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism (PE): Although the patient's symptoms are more consistent with pericarditis, PE is a life-threatening condition that must be considered, especially given the patient's history of cancer (prostate Ca) and chronic steroid use. The patient's pleuritic chest pain and low-grade fever could be consistent with PE, and the diagnosis would be deadly if missed.
- Aortic Dissection: The patient's new murmur and history of hypertension (HTN) increase the risk of aortic dissection. Although the echo showed only aortic sclerosis, aortic dissection is a life-threatening condition that must be considered, especially given the patient's symptoms and risk factors.
- Rare diagnoses
- Tuberculous Pericarditis: Although rare, tuberculous pericarditis is a possibility, especially given the patient's chronic steroid use and elevated inflammatory markers. However, the diagnosis would require further testing, including pericardial fluid analysis and cultures.
- Malignant Pericarditis: The patient's history of prostate cancer increases the risk of malignant pericarditis. However, the diagnosis would require further testing, including pericardial fluid analysis and imaging studies.