Differential Diagnosis for Toxidrome Causing Pleuritic Chest Pain
- Single most likely diagnosis
- Salicylate toxicity: This is a common toxidrome that can cause pleuritic chest pain due to pulmonary edema, which is a known complication of salicylate overdose. The mechanism involves the stimulation of the respiratory center, leading to hyperventilation and subsequent respiratory alkalosis, which can progress to metabolic acidosis. Pleuritic chest pain in this context is often associated with the inflammatory response and potential for acute respiratory distress syndrome (ARDS).
- Other Likely diagnoses
- Carbon monoxide poisoning: While not typically the first consideration for pleuritic chest pain, carbon monoxide (CO) poisoning can lead to cardiac ischemia and pulmonary edema, both of which might present with pleuritic chest pain. CO binds to hemoglobin, reducing oxygen delivery to tissues and potentially causing myocardial ischemia.
- Amphetamine toxicity: Amphetamines can cause pulmonary hypertension and, in severe cases, lead to right heart failure and subsequent pleuritic chest pain due to the increased pressure in the pulmonary vasculature.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumocystis jirovecii pneumonia (PCP) in the context of drug-induced immunosuppression: Certain drugs can suppress the immune system, making patients susceptible to opportunistic infections like PCP, which classically presents with pleuritic chest pain, fever, and shortness of breath.
- Cocaine-induced pneumothorax or pneumomediastinum: Cocaine use can lead to spontaneous pneumothorax or pneumomediastinum, both of which would present with sudden onset of pleuritic chest pain.
- Rare diagnoses
- Nitrofurantoin toxicity: This antibiotic is rarely associated with pulmonary toxicity, which can manifest as pleuritic chest pain among other respiratory symptoms. The reaction is idiosyncratic and can occur at any time during treatment.
- Chemotherapy-induced pneumonitis: Certain chemotherapeutic agents can cause pneumonitis, which may present with pleuritic chest pain. This is a rare but serious side effect that requires prompt recognition and treatment.