What is the differential diagnosis for a patient presenting with acute nausea, abdominal pain, followed by paresthesia (abnormal sensations) in hands progressing proximally, with Magnetic Resonance Imaging (MRI) findings consistent with meningitis, a negative viral panel, and a metallic taste in the mouth?

Lyme Meningitis: Justification - The combination of acute nausea, abdominal pain, paresthesia, and an MRI consistent with meningitis, along with a negative viral panel, points towards a bacterial or tick-borne illness. Lyme disease, caused by Borrelia burgdorferi, can present with meningitis and is known to cause a metallic taste, which aligns with the patient's symptoms.

Syphilitic Meningitis: Justification - This condition, caused by Treponema pallidum, can present with meningitis and has been associated with a range of neurological symptoms, including paresthesia. The metallic taste could also be consistent with this diagnosis.
Tuberculous Meningitis: Justification - Although less common, tuberculous meningitis can present with similar symptoms, including abdominal pain and paresthesia, especially if the disease is advanced. A negative viral panel does not rule out this bacterial infection.
Cryptococcal Meningitis: Justification - This fungal infection can cause meningitis, particularly in immunocompromised patients. While the metallic taste is less commonly associated with this condition, the other symptoms could fit, especially if the patient has a weakened immune system.

Neurosyphilis with Tabes Dorsalis: Justification - This condition is a late manifestation of syphilis and can cause severe neurological symptoms, including paresthesia and abdominal pain. Missing this diagnosis could lead to significant morbidity.
Sarcoidosis: Justification - Neurosarcoidosis can mimic meningitis and cause a wide range of neurological symptoms. It's crucial not to miss this diagnosis due to its potential for severe neurological complications.
Vasculitis (e.g., Giant Cell Arteritis, Primary CNS Vasculitis): Justification - These conditions can cause meningitis-like symptoms and are critical not to miss due to their potential for severe complications, including stroke and vision loss.

Whipple's Disease: Justification - This rare bacterial infection can cause a variety of symptoms, including abdominal pain, weight loss, and neurological symptoms like paresthesia. While it's unlikely, the combination of symptoms could fit, especially if other diagnoses are ruled out.
Ciguatera Fish Poisoning: Justification - This condition, caused by eating contaminated fish, can lead to neurological symptoms, including paresthesia and a metallic taste. It's a rare cause of these symptoms but should be considered in patients with a history of recent fish consumption.