Differential Diagnosis for Case 11

The patient presents with shortness of breath and easy fatigue, which are non-specific symptoms that can be associated with a wide range of conditions. Given the patient's history and physical examination findings, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Anemia: The patient's symptoms of shortness of breath and easy fatigue, combined with his pale appearance, suggest anemia. His history of being homeless and out of work for 18 months may indicate poor nutrition or other factors contributing to anemia, despite his previous normal CBCs.

• Other Likely Diagnoses

  • Chronic Obstructive Pulmonary Disease (COPD): Although the chest exam is normal, COPD could still be a consideration, especially if the patient has a history of smoking or other risk factors.
  • Heart Failure: Fatigue and shortness of breath are common symptoms of heart failure. The absence of abnormal findings on the chest and abdomen exams does not rule out this diagnosis, as heart failure can present subtly.
  • Pulmonary Embolism: While less likely given the lack of specific risk factors or symptoms such as chest pain, pulmonary embolism is a condition that could cause sudden onset of shortness of breath and fatigue.

• Do Not Miss Diagnoses

  • Pneumonia: Despite a normal chest exam, pneumonia can sometimes present with minimal or no findings on physical examination, especially in early stages or in certain populations.
  • Acute Coronary Syndrome (ACS): The symptoms of fatigue and shortness of breath could be atypical presentations of ACS, particularly in a patient with potential risk factors such as stress from being homeless and out of work.
  • Sepsis: Although the patient does not have overt signs of infection, sepsis can present subtly and is a critical condition that requires prompt recognition and treatment.

• Rare Diagnoses

  • Myeloproliferative Neoplasms: Conditions like polycythemia vera or essential thrombocythemia could lead to symptoms due to abnormal blood cell counts, though these would likely have been detected in previous CBCs.
  • Pulmonary Hypertension: This condition can cause shortness of breath and fatigue but is less common and might not be initially suspected without specific risk factors or findings on physical examination.
  • Hemochromatosis: A genetic disorder leading to iron overload, which could cause fatigue and shortness of breath among other symptoms, though it would be unusual for this to present acutely without previous signs.