Differential Diagnosis

The patient's complex medical history and systemic symptoms post-hyaluronidase injection require a comprehensive differential diagnosis. The following categories outline potential diagnoses:

• Single Most Likely Diagnosis
  • Mast Cell Activation Syndrome (MCAS): The patient's symptoms, including systemic reactions to the hyaluronidase injection, fluctuating inflammatory markers, and multiple allergic and autoimmune conditions, are consistent with MCAS. The allergist's assessment and trial of oral Ketotifen further support this diagnosis.
• Other Likely Diagnoses
  • Autoimmune disorders (e.g., lupus, rheumatoid arthritis): The patient's symptoms, such as joint laxity, skin laxity, and fluctuating inflammatory markers, could be indicative of an underlying autoimmune disorder.
  • Hypersensitivity reactions: The patient's history of allergic reactions, including anaphylaxis, and the systemic reaction to the hyaluronidase injection suggest a possible hypersensitivity disorder.
  • Eosinophilic disorders: The patient's high IgE levels, eczema, and history of eosinophils on biopsies may indicate an underlying eosinophilic disorder.
• Do Not Miss Diagnoses
  • Cancer: The patient's history of squamous cell carcinomas and HPV infection necessitates regular monitoring for potential malignancies.
  • Infections: The patient's history of aspergillosis and chronic sinusitis requires consideration of potential underlying infections, including fungal or bacterial infections.
  • Adrenal insufficiency: The patient's symptoms, such as weight loss, muscle weakness, and hot flashes, could be indicative of adrenal insufficiency, which would require prompt diagnosis and treatment.
• Rare Diagnoses
  • Ehlers-Danlos syndrome: The patient's symptoms, such as joint laxity and skin laxity, could be indicative of Ehlers-Danlos syndrome, a rare genetic disorder.
  • Sjögren's syndrome: The patient's symptoms, such as dry eyes and mouth, could be indicative of Sjögren's syndrome, a rare autoimmune disorder.
  • Histamine intolerance: The patient's symptoms, such as flushing, itching, and gastrointestinal issues, could be indicative of histamine intolerance, a rare condition characterized by an inability to break down histamine.