Differential Diagnosis for a 30-year-old Female with Fever and Temporomandibular Joint Pain

Single Most Likely Diagnosis

• Temporomandibular Joint (TMJ) Arthritis: This is the most likely diagnosis given the acute onset of fever followed by moderate pain in the left TMJ. The fever suggests an inflammatory or infectious process, and the localized pain points towards involvement of the TMJ.

Other Likely Diagnoses

• Bruxism or TMJ Strain: Although less likely given the fever, bruxism or strain of the TMJ could cause pain. However, the presence of fever makes this less probable as a primary cause.
• Dental Infection: An infection of a tooth or the surrounding tissues could cause referred pain to the TMJ area and might be accompanied by fever.
• Trigeminal Neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. While it's less likely given the fever, it could be considered if the pain is severe and shock-like.

Do Not Miss Diagnoses

• Lyme Disease: Although rare, Lyme disease can cause fever and joint pain, including the TMJ. Given its potential severity and the importance of early treatment, it should not be missed.
• Juvenile Idiopathic Arthritis (JIA): Now known as Juvenile Rheumatoid Arthritis, this condition can present with fever and joint pain, including the TMJ, in young adults.
• Sepsis or Systemic Infection: Any systemic infection could potentially cause fever and localized pain, including the TMJ, if the infection spreads to the joint.

Rare Diagnoses

• Gout or Pseudogout: These conditions are forms of arthritis that can cause sudden, severe joint pain. While they more commonly affect larger joints, they could potentially affect the TMJ.
• Sjögren's Syndrome: An autoimmune disorder that can cause joint pain, including the TMJ, among other symptoms like dry eyes and mouth.
• Relapsing Polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, potentially affecting the TMJ.

Management Strategy

The management strategy would depend on the diagnosis but could include:

• Anti-inflammatory Medications: For conditions like TMJ arthritis or strain.
• Antibiotics: If a bacterial infection is suspected, such as a dental infection.
• Pain Management: Including over-the-counter pain relievers or, in severe cases, prescription medications.
• Physical Therapy: To help manage TMJ pain and improve function.
• Dental Evaluation: To rule out dental causes of pain.

Medications

• Ibuprofen: An anti-inflammatory that can help with pain and reduce inflammation.
• Acetaminophen: For pain relief.
• Muscle Relaxants: If muscle spasm is contributing to the pain.
• Antibiotics: As needed for bacterial infections.

It's crucial to conduct a thorough evaluation, including a physical examination and potentially imaging studies or blood tests, to determine the underlying cause of the symptoms and guide the management strategy appropriately.