Differential Diagnosis for 68 YOF with Sudden Onset Swelling and Itchiness
- Single Most Likely Diagnosis
- Angioedema: This is the most likely diagnosis given the sudden onset of swelling to the face, neck, and mouth, along with diffuse itchiness. The patient's history of taking an ACE inhibitor (perindopril) for years is a significant risk factor for angioedema, as ACE inhibitors are known to cause this condition in some patients. The recent administration of Benadryl may have been an attempt to alleviate symptoms, but it does not rule out angioedema.
- Other Likely Diagnoses
- Allergic Reaction: Given the patient's report of itchiness throughout the body for the last 2 days and the sudden onset of swelling, an allergic reaction to an unknown substance is possible. The fact that the patient had taken Benadryl suggests an attempt to manage allergic symptoms.
- Urticaria: This condition, characterized by itchy hives, could be a part of the patient's presentation, especially given the diffuse itchiness. However, the swelling of the face and neck suggests angioedema as a more specific diagnosis.
- Do Not Miss Diagnoses
- Anaphylaxis: Although the patient denies shortness of breath (SOB) or dysphagia, anaphylaxis is a life-threatening condition that must be considered, especially with symptoms of widespread itchiness and swelling. The absence of respiratory or gastrointestinal symptoms does not rule out anaphylaxis entirely, as presentations can vary.
- Superior Vena Cava Syndrome: This is a condition where the superior vena cava is obstructed, leading to facial and neck swelling. It is less likely given the sudden onset and the patient's symptoms but is a critical diagnosis not to miss due to its severity and the need for prompt intervention.
- Rare Diagnoses
- Hereditary Angioedema: This is a rare genetic disorder that causes recurrent episodes of severe swelling. It is less likely given the patient's age at presentation and the lack of a reported family history, but it could be considered if other causes are ruled out and the patient experiences recurrent episodes.
- Acquired Angioedema: Associated with conditions like lymphoproliferative disorders or autoimmune diseases, this is a rare cause of angioedema but should be considered if no other explanation is found, especially in an elderly patient with potential underlying health issues.