Differential Diagnosis

The patient presents with a complex set of symptoms, including frequent canker sores, angular chelitis, stomach issues, back and testicular pain, and frequent urination. Considering the timeline, age, behaviors, and symptoms, the following differential diagnoses are proposed:

• Single Most Likely Diagnosis
  • Recurrent Aphthous Stomatitis (Canker Sores) and Angular Chelitis: The patient's history of canker sores and recent increase in frequency, along with angular chelitis, suggests a possible immune system dysregulation or nutritional deficiency. The fact that the boyfriend also developed angular chelitis after being with the patient could indicate a common environmental or dietary factor rather than an infectious cause.
• Other Likely Diagnoses
  • Irritable Bowel Syndrome (IBS): The patient's stomach issues, despite normal test results, could be indicative of IBS, which is often exacerbated by stress.
  • Urinary Tract Issues: The frequent urination could be related to a urinary tract issue, such as overactive bladder or a possible infection.
  • Herniated Discs: The patient's back pain could be related to the herniated discs, which may be causing referred pain to the testicles.
  • Nutritional Deficiency: A deficiency in vitamins such as B12 or iron could be contributing to the patient's canker sores and angular chelitis.
• Do Not Miss Diagnoses
  • Sexually Transmitted Infections (STIs): Although the patient was treated for chlamydia and gonorrhea in the past, it is essential to consider other STIs, such as herpes simplex virus (HSV), which could be causing the canker sores and angular chelitis.
  • Inflammatory Bowel Disease (IBD): Although the patient's test results were normal, IBD (e.g., Crohn's disease or ulcerative colitis) could still be a possibility, and it is crucial to monitor the patient's symptoms and consider further testing if necessary.
  • Testicular Cancer: Although rare, testicular cancer could be a possible cause of the patient's testicular pain, and it is essential to perform a thorough physical examination and consider imaging studies if necessary.
• Rare Diagnoses
  • Behçet's Disease: A rare autoimmune disorder that could be causing the patient's canker sores, angular chelitis, and other symptoms.
  • Sjögren's Syndrome: An autoimmune disorder that could be contributing to the patient's dry mouth and angular chelitis.
  • Celiac Disease: An autoimmune disorder that could be causing the patient's stomach issues and other symptoms.

To further narrow down the differential diagnosis, it would be essential to ask the patient additional questions, such as:

• Can you describe your diet and any recent changes?
• Have you experienced any other symptoms, such as fever, fatigue, or weight loss?
• Have you noticed any triggers for your canker sores or angular chelitis?
• Can you provide more information about your stress levels and how you manage stress?
• Have you had any other medical conditions or allergies in the past?