Differential Diagnosis for a 37-Year-Old Female Patient

Single Most Likely Diagnosis

• Ehlers-Danlos Syndrome (EDS): This diagnosis is considered due to the combination of symptoms such as painful touch, fatigue, migraines, and hyperpigmented lesions, which are common in EDS patients. The presence of a thyroid nodule and past Hashimoto disease could also be related to the autoimmune aspects sometimes associated with EDS. The crusted lesions on the feet could be related to poor wound healing, a feature of some EDS types.

Other Likely Diagnoses

• Fibromyalgia: Given the symptoms of painful touch, fatigue, and migraines, fibromyalgia is a strong consideration. It often co-exists with other conditions like ADHD and thyroid diseases.
• Autoimmune Polyendocrine Syndrome (APS): With a history of Hashimoto disease and the presence of a thyroid nodule, APS could be a consideration, especially if other endocrine abnormalities are found.
• Sjögren's Syndrome: This autoimmune disorder can cause fatigue, thyroid issues, and skin lesions, among other symptoms, making it a plausible diagnosis.

Do Not Miss Diagnoses

• Lymphoma: Although less likely, the presence of systemic symptoms like fatigue, along with skin lesions, necessitates considering lymphoma to avoid a potentially deadly missed diagnosis.
• Sarcoidosis: This condition can cause a wide range of symptoms including skin lesions, fatigue, and endocrine abnormalities, making it crucial not to miss.
• Neurodegenerative Disorders (e.g., Multiple Sclerosis): Given the neurological symptoms like migraines and ADHD, and the potential for demyelinating diseases to cause a wide range of systemic symptoms, these conditions should be considered to avoid missing a serious diagnosis.

Rare Diagnoses

• Mastocytosis: This condition can cause a variety of symptoms including skin lesions, fatigue, and neurological issues due to mast cell degranulation, making it a rare but possible diagnosis.
• Porphyria: Certain types of porphyria can cause skin lesions, neurological symptoms, and abdominal pain (which could contribute to dysmenorrhea), although it is quite rare.
• Scleroderma: While less likely given the specific constellation of symptoms, scleroderma can cause skin thickening, thyroid issues, and other systemic symptoms, making it a rare consideration.