Differential Diagnosis for 32-Year-Old Female Patient

Single Most Likely Diagnosis

• Toxicity due to heavy metal poisoning (specifically mercury and arsenic): Given the high levels of mercury and arsenic, and the presentation of biventricular thrombosis, psychosis, and a history of depression and anxiety, heavy metal poisoning is a strong candidate. Both mercury and arsenic are known to cause neurological, psychiatric, and cardiovascular symptoms.

Other Likely Diagnoses

• Antiphospholipid Syndrome (APS): This condition can cause thrombosis in both ventricles and is associated with psychiatric symptoms, including psychosis. The patient's history of depression and anxiety could also be related to APS.
• Systemic Lupus Erythematosus (SLE): SLE can cause thrombosis, psychosis, and has a high prevalence of psychiatric symptoms. It could be considered, especially if there are other systemic symptoms.
• Catastrophic Antiphospholipid Syndrome (CAPS): A rare but severe form of APS that can cause multiple thrombi and could explain the biventricular thrombosis and psychosis.

Do Not Miss Diagnoses

• Thrombotic Thrombocytopenic Purpura (TTP): Although less likely, TTP can cause thrombosis in small blood vessels and can present with neurological symptoms, including psychosis. It's critical to rule out due to its high mortality if untreated.
• Disseminated Intravascular Coagulation (DIC): This condition can cause widespread thrombosis and could be a complication of severe infection or trauma. It's essential to consider due to its high mortality rate.
• Pulmonary Embolism (PE) with paradoxical embolism: Although the primary issue seems to be biventricular thrombosis, the possibility of a PE with paradoxical embolism causing thrombi in both ventricles should not be overlooked, especially given the risk of sudden death.

Rare Diagnoses

• Sneddon's Syndrome: A rare condition characterized by livedo reticularis and cerebrovascular events, which could potentially explain some of the patient's symptoms, including thrombosis and psychosis.
• Churg-Strauss Syndrome: A form of vasculitis that can cause thrombosis and has been associated with psychiatric symptoms. It's rare but should be considered if other diagnoses are ruled out.
• Neurosyphilis: In the context of psychosis and given the broad range of symptoms syphilis can cause, neurosyphilis is a rare but possible diagnosis that should be considered, especially if other tests are inconclusive.