Differential Diagnosis
The patient's complex presentation of symptoms requires a comprehensive differential diagnosis. The following categories outline potential diagnoses:
Single Most Likely Diagnosis
- Systemic Lupus Erythematosus (SLE): This autoimmune disorder can cause a wide range of symptoms, including joint inflammation, neurological issues (such as numbness, tingling, and seizures), cardiovascular problems (like irregular heart rate), gastrointestinal symptoms (bloating, diarrhea, abdominal pain), and systemic symptoms (nocturnal fevers, pruritus). The presence of multiple systemic symptoms makes SLE a strong candidate.
Other Likely Diagnoses
- Rheumatoid Arthritis (RA): While primarily known for joint inflammation, RA can also cause systemic symptoms, including fever, and has associations with neurological and cardiovascular issues. However, the breadth of neurological and gastrointestinal symptoms might be less typical for RA.
- Multiple Sclerosis (MS): This condition could explain the neurological symptoms (lower leg weakness, numbness, and tingling in one arm, history of a seizure). However, MS typically doesn't cause systemic symptoms like nocturnal fevers or the specific gastrointestinal symptoms mentioned.
- Fibromyalgia: Could be considered for the widespread pain, bloating, and possibly the neurological symptoms, but it doesn't fully account for the systemic or specific gastrointestinal symptoms.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could explain the gastrointestinal symptoms and potentially some systemic symptoms, but they wouldn't fully account for the neurological or cardiovascular findings.
Do Not Miss Diagnoses
- Neurosyphilis: This condition can cause a wide range of neurological symptoms, including weakness, numbness, and seizures. It's crucial to rule out due to its treatability and potential for severe consequences if left untreated.
- Lyme Disease: Can cause neurological symptoms, joint inflammation, and systemic symptoms. Given its potential for serious neurological and cardiac complications, it's essential to consider, especially if the patient has been exposed to ticks.
- Sjögren's Syndrome: An autoimmune disorder that can cause systemic symptoms, including joint pain, and has associations with neurological issues. It's less likely but important to consider due to its potential impact on quality of life.
Rare Diagnoses
- Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues, potentially explaining some of the neurological and gastrointestinal symptoms, as well as joint issues. However, it's a rare condition and would not typically cause all the symptoms listed.
- Mitochondrial Myopathies: These are a group of disorders that affect the mitochondria, leading to muscle weakness and potentially other systemic symptoms. They are rare and might not fully explain the breadth of symptoms presented.
- Porphyrias: A group of rare disorders that can cause neurological symptoms, abdominal pain, and systemic symptoms. Some types can cause motor weakness, especially after certain activities like sex, due to the neurological effects of the disease.