Differential Diagnosis
- Single Most Likely Diagnosis
- Fibromyalgia: The patient's chronic widespread pain, tender points, fatigue, sleep disturbances, and cognitive symptoms (brain fog, emotional changes) are all consistent with fibromyalgia. The presence of irritable bowel symptoms (loose stools) and sensitivity to temperature extremes also support this diagnosis.
- Other Likely Diagnoses
- Systemic Lupus Erythematosus (SLE): The patient's increasing ANA score, although fluctuating, suggests the possibility of an autoimmune disorder like SLE. The presence of chronic headaches, fatigue, and skin rashes (possibly photosensitive) also align with SLE.
- Endometriosis: The patient's severe dysmenorrhea (painful periods), heavy menstrual bleeding, and sharp cramping that worsens with defecation are suggestive of endometriosis. The presence of a copper IUD, which can exacerbate endometriosis symptoms, further supports this diagnosis.
- Irritable Bowel Syndrome (IBS): The patient's chronic loose stools and abdominal cramping, particularly during menstruation, are consistent with IBS.
- Migraine: The patient's chronic headaches, particularly the migraine on the left side behind the eye, suggest a migraine disorder.
- Do Not Miss Diagnoses
- Multiple Sclerosis: Although less likely, the patient's symptoms of decreased coordination, worsening depth perception, and numbness in hands and feet, particularly in cold temperatures, warrant consideration of multiple sclerosis.
- Thyroid Disorder: The patient's fatigue, brain fog, and intolerance to temperature extremes could be indicative of a thyroid disorder, such as hypothyroidism.
- Vasculitis: The patient's skin rashes, particularly the hive-like and splotchy appearance, could be suggestive of a vasculitis disorder, such as urticarial vasculitis.
- Rare Diagnoses
- Ehlers-Danlos Syndrome: The patient's easy bruising, joint hypermobility (implied by decreased coordination), and skin tender points could be indicative of Ehlers-Danlos syndrome.
- Porphyria: The patient's sensitivity to sunlight, heat intolerance, and abdominal pain could be suggestive of a porphyria disorder, such as acute intermittent porphyria.
- Mitochondrial Myopathy: The patient's chronic fatigue, muscle pain, and intolerance to temperature extremes could be indicative of a mitochondrial myopathy disorder.