Differential Diagnosis
The patient's complex presentation of symptoms requires a comprehensive differential diagnosis. The following categories outline potential diagnoses:
- Single most likely diagnosis
- Multiple Sclerosis (MS): This diagnosis is considered due to the combination of neurologic symptoms such as lower leg weakness, numbness, and tingling in one arm, which are indicative of demyelinating lesions in the central nervous system. The history of a seizure also supports this diagnosis, as seizures can occur in MS patients. Additionally, the presence of motor weakness after sex could be related to the Uhthoff's phenomenon, where increased body temperature can exacerbate MS symptoms.
- Other Likely diagnoses
- Systemic Lupus Erythematosus (SLE): The patient's symptoms of inflammatory joints, nocturnal fevers, and pruritus could be indicative of SLE, an autoimmune disease that can affect multiple organ systems. The neurologic symptoms and history of a seizure also align with SLE, as neuropsychiatric manifestations can occur in this disease.
- Rheumatoid Arthritis (RA): The presence of inflammatory joints and systemic symptoms such as fevers and pruritus could suggest RA, an autoimmune disease that primarily affects the joints. However, the neurologic symptoms and history of a seizure are less typical for RA.
- Sjögren's Syndrome: This autoimmune disease can cause systemic symptoms such as joint inflammation, fevers, and pruritus, as well as neurologic symptoms like numbness and tingling. However, the history of a seizure and motor weakness after sex are less characteristic of Sjögren's Syndrome.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Multiple System Atrophy (MSA): Although less likely, MSA is a rare neurodegenerative disorder that can cause autonomic dysfunction, leading to symptoms like orthostatic hypotension, urinary incontinence, and erectile dysfunction. The patient's motor weakness after sex could be related to autonomic dysfunction.
- Neuromyelitis Optica Spectrum Disorder (NMOSD): This rare autoimmune disease can cause optic neuritis, transverse myelitis, and brainstem encephalitis, leading to symptoms like numbness, tingling, and weakness. The history of a seizure and motor weakness after sex could be indicative of NMOSD.
- Lyme Disease: Although less likely, Lyme disease can cause a wide range of symptoms, including neurologic manifestations like numbness, tingling, and weakness, as well as systemic symptoms like fevers and joint inflammation.
- Rare diagnoses
- Mitochondrial Myopathies: These rare genetic disorders can cause muscle weakness, numbness, and tingling, as well as systemic symptoms like fevers and joint inflammation. The patient's motor weakness after sex could be related to a mitochondrial myopathy.
- Paraneoplastic Syndromes: These rare disorders occur in response to a underlying cancer and can cause a wide range of symptoms, including neurologic manifestations like numbness, tingling, and weakness, as well as systemic symptoms like fevers and joint inflammation.
- Ehlers-Danlos Syndrome: This rare genetic disorder can cause joint hypermobility, skin hyperextensibility, and tissue fragility, as well as systemic symptoms like fevers and gastrointestinal symptoms. The patient's symptoms of bloating, diarrhea, and abdominal pain could be related to Ehlers-Danlos Syndrome.