Differential Diagnosis for Chest Pain with Associated Symptoms

The patient's presentation of chest pain with associated shortness of breath, negative fevers, productive cough, and recent travel to the Middle East suggests a range of potential diagnoses. Here is a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Pulmonary Embolism (PE): Given the combination of chest pain, shortness of breath, and recent travel (which increases the risk of deep vein thrombosis and subsequently PE), this diagnosis is highly plausible. The absence of fever does not rule out PE, as it is not a universal symptom.

• Other Likely Diagnoses

  • Community-Acquired Pneumonia (CAP): Despite the mention of "negative fevers," which might be interpreted as low-grade or no fever, CAP remains a consideration, especially with a productive cough and recent travel, which could expose the patient to various pathogens.
  • Acute Coronary Syndrome (ACS): Although less likely in a 35-year-old without traditional risk factors, ACS cannot be immediately ruled out, especially if the chest pain is suggestive of ischemic origin.
  • Tuberculosis (TB): Given the travel to the Middle East, where TB prevalence can be higher than in some Western countries, and symptoms like productive cough, TB should be considered, especially if the patient has been exposed to someone with TB or has other risk factors.

• Do Not Miss Diagnoses

  • Pulmonary Tuberculosis with Hemoptysis: Although the patient does not mention hemoptysis, any pulmonary infection, especially in a region with high TB prevalence, necessitates consideration of this potentially life-threatening condition if missed.
  • SARS-CoV-2 or Other Viral Infections: Given the travel history and symptoms that could align with COVID-19 or other viral respiratory infections, these should not be missed, especially considering the global impact of such diseases.
  • Aortic Dissection: This is a medical emergency that presents with chest pain and could be associated with shortness of breath. Although less common, it is critical not to miss this diagnosis due to its high mortality rate if untreated.

• Rare Diagnoses

  • MERS-CoV or Other Middle East Respiratory Syndrome: Given the travel to the Middle East, although rare, MERS-CoV should be considered, especially if the patient has had contact with camels or been in a healthcare setting where MERS-CoV cases have been reported.
  • Histoplasmosis or Other Fungal Infections: If the patient has been exposed to certain environments (like caves or bird droppings) during travel, fungal infections could be a rare but possible cause of symptoms.
  • Q Fever: Caused by Coxiella burnetii, this could be considered if the patient has had contact with animals or their products during travel, though it is less common.

Each of these diagnoses requires careful consideration of the patient's full history, physical examination, and appropriate diagnostic testing to determine the underlying cause of the symptoms.