Differential Diagnosis
- Single most likely diagnosis
- Acute shigellosis, infectious-toxic shock: This diagnosis is the most likely due to the acute onset of symptoms such as fever, abdominal cramps, and profuse, fetid diarrhea, which are characteristic of shigellosis. The patient's severe condition, including hypotension (80/40 mmHg), tachycardia (115 beats per minute), and lack of urine output, suggests infectious-toxic shock. The recent history of eating scrambled eggs, which could be contaminated, supports a foodborne illness like shigellosis.
- Other Likely diagnoses
- Salmonellosis, infectious-toxic shock: Similar to shigellosis, salmonellosis can cause severe gastrointestinal symptoms and lead to infectious-toxic shock, especially in vulnerable populations like pregnant women. The consumption of potentially contaminated food (scrambled eggs) is a risk factor for salmonellosis.
- Salmonellosis, hypovolemic shock: While the primary concern is infectious-toxic shock, hypovolemic shock due to severe dehydration from diarrhea and vomiting is also a possibility, especially given the patient's low blood pressure and dry mucous membranes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pregnancy-related complications (e.g., ectopic pregnancy, miscarriage): Although the symptoms presented do not directly suggest these conditions, any pregnant woman presenting with severe abdominal pain and systemic symptoms warrants consideration of pregnancy-related emergencies, which can be life-threatening if not promptly diagnosed and treated.
- Septic abortion: Given the early stage of pregnancy, any infection or severe illness could potentially lead to or be complicated by a septic abortion, especially if the patient has undergone any intervention or has a history suggestive of this.
- Rare diagnoses
- Food poisoning from other pathogens (e.g., E. coli, Campylobacter): While less likely given the specific symptoms and context, other foodborne pathogens could cause similar presentations and should be considered, especially if common causes like Salmonella or Shigella are ruled out.
- Toxins or other non-infectious causes of gastrointestinal illness: Though less likely, toxins or other non-infectious causes could mimic the symptoms presented and should be considered in the differential diagnosis, especially if an infectious cause is not confirmed.