Differential Diagnosis for a 75-year-old Indian Lady with Nausea, Vomiting, Loose Stools, History of Cold, and Wheeze

• Single Most Likely Diagnosis:
  • Gastroenteritis: This is likely due to the combination of nausea, vomiting, and loose stools, which are common symptoms of a gastrointestinal infection. The recent history of a cold could also suggest a viral etiology.
• Other Likely Diagnoses:
  • Asthma or COPD Exacerbation: The presence of wheeze, especially in the context of a recent cold, could indicate an exacerbation of asthma or chronic obstructive pulmonary disease (COPD), which are common in elderly populations.
  • Pneumonia: Given the history of a cold and the presence of wheeze, pneumonia should be considered, especially in an elderly patient who may not present with typical symptoms such as high fever or cough.
  • Food Poisoning: This could also explain the gastrointestinal symptoms and should be considered, especially if the patient has recently consumed potentially contaminated food or water.
• Do Not Miss Diagnoses:
  • Pulmonary Embolism: Although less likely, pulmonary embolism can present with nonspecific symptoms such as wheeze and could be deadly if missed. Elderly patients are at higher risk for pulmonary embolism.
  • Heart Failure: Exacerbation of heart failure could present with wheeze (cardiac asthma) and gastrointestinal symptoms due to decreased perfusion. It's crucial not to miss this diagnosis due to its high mortality rate if not promptly treated.
  • Infectious Diarrhea with Dehydration: In elderly patients, dehydration from infectious diarrhea can quickly lead to severe complications, including renal failure and death.
• Rare Diagnoses:
  • Eosinophilic Gastroenteritis: This rare condition could explain the gastrointestinal symptoms along with wheeze if the patient has an allergic component to their disease.
  • Churg-Strauss Syndrome: A rare autoimmune condition that could present with asthma-like symptoms (wheeze), gastrointestinal symptoms, and a history of recent upper respiratory infection. However, it is much less common and would typically be considered after other diagnoses have been ruled out.