Differential Diagnosis
- Single most likely diagnosis
- Smoldering Multiple Myeloma: The presence of monoclonal plasma cells, a sharply abnormal cytoplasmic kappa:lambda light chain ratio, and the patient's symptoms such as recurrent boils, rash, and body pain suggest a plasma cell disorder. The decision to order a PET/CT whole body scan and the consideration of a bone marrow biopsy further support this diagnosis.
- Other Likely diagnoses
- High-Risk Monoclonal Gammopathy of Undetermined Significance (MGUS): The patient's laboratory results, including the presence of monoclonal plasma cells and an abnormal light chain ratio, could also be consistent with high-risk MGUS, which is a precursor to multiple myeloma.
- Systemic Vasculitis: The patient's symptoms of rash, body pain, and ulcers could be indicative of a systemic vasculitis, such as polyarteritis nodosa or granulomatosis with polyangiitis.
- Autoimmune Disorder: The patient's symptoms of rash, body pain, and recurrent ulcers could also be suggestive of an autoimmune disorder, such as lupus or rheumatoid arthritis.
- Do Not Miss
- Infectious Endocarditis: The patient's history of recurrent boils and body pain could be indicative of infectious endocarditis, which is a life-threatening condition if not promptly diagnosed and treated.
- Sepsis: The patient's symptoms of body pain, rash, and ulcers could be indicative of sepsis, which is a life-threatening condition if not promptly diagnosed and treated.
- Rare diagnoses
- POEMS Syndrome: The patient's symptoms of rash, body pain, and recurrent ulcers, combined with the presence of monoclonal plasma cells, could be suggestive of POEMS syndrome, a rare plasma cell disorder.
- Castleman Disease: The patient's symptoms of body pain, rash, and recurrent ulcers could be indicative of Castleman disease, a rare lymphoproliferative disorder.