Differential Diagnosis for Acute Nausea, Abdominal Pain, Paresthesia, and Meningitis
Single Most Likely Diagnosis
- Heavy Metal Poisoning (e.g., Lead, Mercury, Arsenic): The combination of acute nausea, abdominal pain, paresthesia moving proximally, and a metallic taste in the mouth, along with meningitis suggested by MRI, points towards heavy metal poisoning. These substances can cause neurological symptoms, gastrointestinal distress, and the described sensory disturbances.
Other Likely Diagnoses
- Carbon Monoxide Poisoning: Although less likely given the specific constellation of symptoms, carbon monoxide poisoning can cause neurological symptoms, including paresthesia, and can lead to severe complications if not promptly treated.
- Organophosphate Poisoning: This could explain the neurological symptoms and the gastrointestinal distress. However, the pattern of paresthesia and the metallic taste might be less typical.
Do Not Miss Diagnoses
- Botulism: A potentially deadly condition that can cause neurological symptoms, including paresthesia, and gastrointestinal symptoms. Early diagnosis is crucial for treatment.
- Tetanus: Although the presentation might not fully align, tetanus can cause severe neurological symptoms, and its diagnosis should be considered in the context of acute neurological deterioration.
- Rabies: Given the viral panel is negative, but considering the neurological symptoms, rabies, though rare, should not be missed due to its almost invariably fatal outcome if not treated promptly.
Rare Diagnoses
- Thallium Poisoning: Known for causing neurological symptoms, including paresthesia, and can lead to severe complications. The metallic taste and the progression of symptoms could fit, but it's less common.
- Ciguatera Fish Poisoning: This can cause gastrointestinal and neurological symptoms, including paresthesia, but the context (recent fish consumption) and the full spectrum of symptoms would need to align closely for this to be considered a likely diagnosis.
Each of these diagnoses should be considered in the context of the patient's full clinical presentation, exposure history, and additional diagnostic testing as necessary.