Differential Diagnosis
- Single most likely diagnosis
- Giant Cell Arteritis (GCA): This diagnosis is most likely due to the patient's age, symptoms of headaches, myalgias, low-grade fevers, weight loss, and tenderness in the scalp, temporal areas, and proximal muscles. The elevated erythrocyte sedimentation rate (ESR) also supports this diagnosis. GCA is a large vessel vasculitis that can lead to visual impairment if not treated promptly.
- Other Likely diagnoses
- Polymyalgia Rheumatica (PMR): This condition is closely related to GCA and presents with similar symptoms such as myalgias, low-grade fevers, and weight loss. However, PMR typically does not cause visual impairment.
- Temporal Arteritis: This is another term for GCA, but it can also refer to a more localized form of the disease. The patient's symptoms are consistent with temporal arteritis, which can also lead to visual impairment if not treated.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Vasculitis (e.g., Wegener's granulomatosis, microscopic polyangiitis): These conditions can cause similar symptoms to GCA, but they can also affect other organs such as the kidneys and lungs, leading to more severe complications like renal failure.
- Infections (e.g., endocarditis, osteomyelitis): These conditions can cause fever, weight loss, and elevated ESR, and can be life-threatening if not treated promptly.
- Malignancy (e.g., lymphoma, multiple myeloma): These conditions can cause weight loss, fever, and elevated ESR, and can be deadly if not diagnosed and treated early.
- Rare diagnoses
- Relapsing Polychondritis: This is a rare autoimmune disorder that can cause inflammation of the cartilage and other tissues, leading to symptoms such as fever, weight loss, and myalgias.
- Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome): This is a rare autoimmune disorder that can cause vasculitis, fever, weight loss, and myalgias.
The patient is at increased risk for the development of visual impairment (E) if left untreated, due to the high likelihood of Giant Cell Arteritis (GCA) or temporal arteritis.