Viral Differential Diagnosis for Achy Joints and Proximal Thoracic Pain
The symptoms described, including achy joints and proximal thoracic pain that worsens with deep breathing, coughing, or movement, can be indicative of several viral infections. Here's a differential diagnosis categorized for clarity:
Single Most Likely Diagnosis
- Coxsackievirus B: This virus is known to cause pleurodynia, also known as Bornholm disease, characterized by severe chest pain that worsens with breathing or movement, along with fever and myalgias. The symptoms closely match those described.
Other Likely Diagnoses
- Influenza: Influenza viruses can cause severe body aches, including joint pain and chest discomfort that may worsen with deep breathing or coughing.
- Respiratory Syncytial Virus (RSV): While more commonly associated with respiratory illness in infants, RSV can cause significant morbidity in adults, including chest pain and discomfort.
- Adenovirus: Adenoviral infections can present with a wide range of symptoms, including fever, myalgias, and chest pain, especially if there's involvement of the respiratory tract.
Do Not Miss Diagnoses
- COVID-19: Given its global impact and varied presentations, COVID-19 must be considered, especially if there's any exposure history or epidemiological link. Chest pain and myalgias are common symptoms.
- Hantavirus: Though less common, hantavirus infection can cause hantavirus pulmonary syndrome (HPS), characterized by severe respiratory symptoms, including chest pain, and can be fatal if not recognized early.
Rare Diagnoses
- Chikungunya: This viral infection, transmitted by mosquitoes, causes severe joint pain and swelling, along with fever and muscle pain. While less likely in areas without recent travel history to endemic regions, it's a consideration in the differential diagnosis.
- Dengue Fever: Similar to chikungunya, dengue fever is characterized by severe muscle and joint pains, along with a characteristic rash and can present with chest pain due to hemorrhagic manifestations or pleural effusions in severe cases.
Each of these diagnoses has a unique set of additional symptoms and epidemiological factors that can help guide the diagnosis. Laboratory testing, including PCR and serology, is crucial for confirming the specific viral etiology.