What diagnosis would explain gastrointestinal symptoms of bloating, nausea, vomiting, and diarrhea in a patient with scleroderma (systemic sclerosis) on hydroxychloroquine (Plaquenil) and prednisone?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: March 31, 2025 • View editorial policy

Differential Diagnosis for Gastrointestinal Symptoms in a Patient with Scleroderma

Single Most Likely Diagnosis

  • Gastrointestinal involvement of scleroderma: Scleroderma is a systemic disease that can affect the gastrointestinal tract, leading to symptoms such as bloating, nausea, vomiting, and diarrhea due to esophageal dysmotility, gastropardesis, or intestinal involvement.

Other Likely Diagnoses

  • Prednisone-induced gastrointestinal side effects: Prednisone can cause gastrointestinal side effects such as nausea, vomiting, and diarrhea, especially when taken in conjunction with other medications like hydroxychloroquine.
  • Hydroxychloroquine-induced gastrointestinal side effects: Hydroxychloroquine can also cause gastrointestinal side effects such as nausea, vomiting, and diarrhea, which may be exacerbated by concurrent use of prednisone.
  • Infectious gastroenteritis: This is a common cause of gastrointestinal symptoms and should be considered, especially if the patient has recently traveled or been exposed to others with similar symptoms.

Do Not Miss Diagnoses

  • Gastrointestinal bleeding: Patients on prednisone and hydroxychloroquine may be at increased risk of gastrointestinal bleeding, which can present with nausea, vomiting, and diarrhea.
  • Intestinal obstruction: Scleroderma can cause intestinal fibrosis and narrowing, leading to intestinal obstruction, which is a medical emergency.
  • Inflammatory bowel disease: Although less common, inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis) can cause similar symptoms and should be considered, especially if the patient has a history of gastrointestinal symptoms.

Rare Diagnoses

  • Amyocrine tumors: These rare tumors can produce vasoactive intestinal peptide (VIP), leading to symptoms such as diarrhea, nausea, and vomiting.
  • Celiac disease: Although rare, celiac disease can cause gastrointestinal symptoms similar to those experienced by the patient and should be considered, especially if the patient has a history of gastrointestinal symptoms or a family history of celiac disease.
  • Neuroendocrine tumors: These rare tumors can produce hormones that cause gastrointestinal symptoms such as diarrhea, nausea, and vomiting.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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