Differential Diagnosis
- Single most likely diagnosis
- Smoldering Myeloma or High-Risk Monoclonal Gammopathy of Undetermined Significance (MGUS): The presence of monoclonal plasma cells, a sharply abnormal free light chain (FLC) ratio, and the patient's clinical presentation (e.g., recurrent boils, rash, body pain, and slow healing) suggest a plasma cell disorder. The decision to pursue a PET/CT whole body and bone marrow biopsy further supports this consideration, aiming to differentiate between high-risk MGUS and smoldering myeloma.
- Other Likely diagnoses
- Systemic Lupus Erythematosus (SLE): The patient's symptoms, such as body pain, rash, and ulcers, could be indicative of SLE, an autoimmune disease that can affect multiple systems and present with a wide range of symptoms.
- Vasculitis: The description of the patient's rash and ulcers, along with the presence of body pain and flank pain, could suggest a form of vasculitis, which involves inflammation of the blood vessels.
- Sjögren's Syndrome: Although less directly related to the patient's primary complaints, Sjögren's Syndrome is an autoimmune disorder that could potentially explain some of the systemic symptoms and should be considered in the differential diagnosis of a patient with widespread symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): This is a form of vasculitis that can affect various parts of the body, including the skin, kidneys, and lungs. It is crucial to consider due to its potential for severe complications if left untreated.
- Sepsis or Chronic Infection: The patient's history of recurrent boils and slow-healing ulcers could indicate a chronic infection or a condition predisposing to infections, such as an immunodeficiency. Sepsis, although not directly suggested by the information provided, is always a critical consideration in patients with signs of infection.
- Rare diagnoses
- Ehlers-Danlos Syndrome: This group of disorders affects connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. The patient's easy bruising, poor wound healing, and possibly the nature of her ulcers might suggest this, although it's less directly linked to the primary symptoms.
- POEMS Syndrome: A rare, paraneoplastic syndrome associated with a plasma cell disorder, characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes. The presence of monoclonal plasma cells and some of the patient's symptoms (e.g., skin changes, possibly the body pain) could make this a consideration, although it is rare.