Differential Diagnosis for ESR 35 and ANA Positive
Single Most Likely Diagnosis
- Systemic Lupus Erythematosus (SLE): This is the most likely diagnosis given the positive ANA and elevated ESR, as SLE is a chronic autoimmune disease characterized by the presence of ANA and often presents with elevated inflammatory markers such as ESR.
Other Likely Diagnoses
- Rheumatoid Arthritis (RA): Although RA is more commonly associated with RF positivity, some patients can have a positive ANA, and an elevated ESR is common in active disease.
- Sjögren's Syndrome: This autoimmune disorder often presents with a positive ANA and can cause an elevation in ESR due to chronic inflammation.
- Mixed Connective Tissue Disease (MCTD): MCTD combines features of SLE, RA, and scleroderma, often with a positive ANA and elevated ESR.
Do Not Miss Diagnoses
- Hodgkin's Lymphoma: Although less common, certain lymphomas can present with a positive ANA and elevated ESR due to paraneoplastic phenomena or chronic inflammation.
- Endocarditis: Infective endocarditis can cause an elevation in ESR and, in some cases, a positive ANA, especially if there is an associated autoimmune response.
- Thyroiditis: Hashimoto's thyroiditis can sometimes present with a positive ANA and elevated ESR, particularly if there is significant inflammation.
Rare Diagnoses
- Scleroderma: While scleroderma can present with a positive ANA, it is less commonly associated with a significantly elevated ESR unless there is significant organ involvement or an overlap syndrome.
- Polymyositis/Dermatomyositis: These inflammatory myopathies can have a positive ANA and elevated ESR but are less common than other diagnoses listed here.
- Autoimmune Hepatitis: This condition can present with a positive ANA and elevated liver enzymes, and while less common, it should be considered in the differential diagnosis, especially with liver involvement.