Differential Diagnosis for Prolonged Fever with Chest Pain

The patient's symptoms of fever for 5 days, with the temperature typically rising in the evening accompanied by chest pain, suggest a range of possible diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Pneumonia: This is a common condition that can cause fever and chest pain, especially if the pain worsens with deep breathing (pleuritic chest pain). The fever pattern, with temperatures often spiking in the evening, is consistent with an infectious process like pneumonia.

• Other Likely Diagnoses

  • Pulmonary Embolism: While less common than pneumonia, pulmonary embolism can cause chest pain and fever, especially if there is associated pulmonary infarction. The chest pain in pulmonary embolism can be sudden in onset and may worsen with deep breathing.
  • Tuberculosis (TB): TB can cause a chronic fever and chest pain, particularly if there is pleural involvement. The fever in TB often has a diurnal variation, being worse in the evening.
  • Influenza or Other Viral Respiratory Infections: These can cause fever and chest pain, especially if there is an associated pneumonia or pleurisy.

• Do Not Miss Diagnoses

  • Lung Abscess: A lung abscess can cause fever, chest pain, and cough and can be life-threatening if not treated promptly. It's less common but critical not to miss due to its severity and need for specific antibiotic treatment.
  • Endocarditis: Infective endocarditis can cause fever and may have chest pain if there is associated pulmonary embolism or myocardial involvement. It's a diagnosis that requires prompt identification and treatment to prevent serious complications.
  • Sepsis: Sepsis, particularly if originating from a pulmonary source like pneumonia, can cause fever and chest pain. Early recognition and treatment of sepsis are crucial to prevent high mortality.

• Rare Diagnoses

  • Lymphoma: Certain types of lymphoma can cause fever and chest pain, especially if there is mediastinal involvement.
  • Sarcoidosis: This condition can cause fever, chest pain, and respiratory symptoms, although it is less common and typically has a more chronic presentation.
  • Eosinophilic Pneumonia: A rare condition that can cause fever, chest pain, and respiratory symptoms, often associated with eosinophilia.

Each of these diagnoses has a different set of implications for treatment and prognosis, highlighting the importance of a thorough diagnostic evaluation to determine the underlying cause of the patient's symptoms.