Differential Diagnosis for 34-year-old Black Male with Abdominal Pain and Elevated Annelise
- Single most likely diagnosis:
- Systemic Lupus Erythematosus (SLE): The patient's positive ANA, elevated ESR, and chronic abdominal pain are consistent with SLE, an autoimmune disease that can affect multiple organ systems. The normal GI scope and CBC results do not rule out SLE, as it can present with non-specific symptoms and normal laboratory results.
- Other Likely diagnoses:
- Inflammatory Bowel Disease (IBD): Although the GI scope was normal, IBD (e.g., Crohn's disease, ulcerative colitis) can cause chronic abdominal pain and elevated inflammatory markers. The normal scope does not entirely rule out IBD, as it can be patchy or affect areas not visualized by the scope.
- Sarcoidosis: This autoimmune disease can cause abdominal pain, elevated ESR, and positive ANA. Sarcoidosis can affect multiple organs, including the GI tract, and may not be detected by a normal GI scope.
- Do Not Miss diagnoses:
- Lymphoma: Although less likely, lymphoma can cause chronic abdominal pain, elevated ESR, and positive ANA. It is essential to consider lymphoma, as it can be life-threatening if not diagnosed and treated promptly.
- Vasculitis: Conditions like polyarteritis nodosa or granulomatosis with polyangiitis can cause abdominal pain, elevated ESR, and positive ANA. Vasculitis can be life-threatening if not recognized and treated aggressively.
- Rare diagnoses:
- Whipple's disease: A rare, systemic bacterial infection that can cause chronic abdominal pain, weight loss, and elevated inflammatory markers. Although unlikely, Whipple's disease can be diagnosed with a small bowel biopsy or PCR testing.
- Abdominal angina due to chronic mesenteric ischemia: This rare condition can cause chronic abdominal pain, especially after eating. It is essential to consider this diagnosis, especially if the patient has risk factors for atherosclerosis.