Differential Diagnosis for Generalized Pruritis in a Patient with Severe and Enduring Eating Disorder, Jak 2 Negative
- Single Most Likely Diagnosis
- Malnutrition and/or micronutrient deficiencies: Given the patient's severe and enduring eating disorder, malnutrition and deficiencies in essential micronutrients such as vitamin B12, iron, or zinc are highly plausible causes of generalized pruritis. These deficiencies can lead to skin symptoms, including pruritis.
- Other Likely Diagnoses
- Psychogenic pruritis: The psychological distress associated with eating disorders can manifest as psychogenic pruritis, where the pruritis is of psychological origin rather than a direct result of the eating disorder itself.
- Hepatic dysfunction: Liver disease, which can be secondary to malnutrition or other factors, may cause pruritis due to the buildup of bile salts in the skin.
- Renal dysfunction: Kidney disease, potentially related to malnutrition or other comorbid conditions, can lead to pruritis due to the accumulation of uremic toxins.
- Do Not Miss Diagnoses
- Hodgkin lymphoma: Although less common, Hodgkin lymphoma can present with generalized pruritis as an initial symptom. Given the potential severity of this condition, it is crucial not to miss this diagnosis.
- Thyroid disorders: Both hyperthyroidism and hypothyroidism can cause pruritis. Given the potential impact on the patient's condition, thyroid function should be evaluated.
- Primary biliary cholangitis (PBC): An autoimmune disease of the liver that can cause pruritis due to bile salt accumulation. It's essential to consider this diagnosis due to its specific treatment options.
- Rare Diagnoses
- Parathyroid disorders: Hyperparathyroidism can lead to increased calcium levels, which in rare cases may cause pruritis.
- Polycythemia vera (despite Jak 2 negative): Although the patient is Jak 2 negative, which reduces the likelihood, it's not a definitive exclusion criterion for polycythemia vera, and rare cases might still present with pruritis.
- Neurological disorders: Certain neurological conditions, such as multiple sclerosis or neuropathies, can cause pruritis, although this would be less common in the context provided.