Differential Diagnosis for 38F with Dry Eyes, Dry Mouth, and Nocturnal SOB
Single Most Likely Diagnosis
- Sjögren's syndrome: This autoimmune disorder is characterized by dry eyes (xerophthalmia) and dry mouth (xerostomia), which are key symptoms presented by the patient. The presence of psoriasis and celiac disease in the patient's past medical history also suggests an autoimmune predisposition, making Sjögren's syndrome a plausible diagnosis. Nocturnal shortness of breath (SOB) could be related to pulmonary involvement in Sjögren's syndrome.
Other Likely Diagnoses
- Sarcoidosis: This condition can cause dry eyes and mouth, as well as pulmonary symptoms like SOB. It can also involve other organs and might explain some of the patient's unexplained symptoms.
- Thyroid disease: Both hypothyroidism and hyperthyroidism can cause dry eyes and mouth, and thyroid dysfunction can lead to respiratory symptoms. Given the patient's autoimmune history (psoriasis and celiac disease), an autoimmune thyroiditis (like Hashimoto's or Graves' disease) is possible.
- Gastroesophageal reflux disease (GORD) exacerbation: Although the patient has been trialed on PPIs with minimal effect, it's possible that the GORD is not well-controlled or that there are other contributing factors to the nocturnal SOB, such as aspiration or severe esophageal dysmotility.
Do Not Miss Diagnoses
- Pulmonary embolism: Although less likely given the chronic nature of the symptoms and the normal initial workup, pulmonary embolism can cause sudden onset of SOB and would be catastrophic if missed.
- Cardiac disease (e.g., heart failure, coronary artery disease): These conditions can cause SOB and might not be immediately apparent on initial screening tests, especially if the patient is relatively young. However, they are critical to diagnose due to their significant impact on morbidity and mortality.
- Interstitial lung disease (ILD): Given the patient's history of autoimmune diseases, an ILD related to these conditions (e.g., rheumatoid arthritis-associated ILD, although the patient's specific autoimmune diseases are not typically associated with ILD) or a primary ILD could explain the respiratory symptoms.
Rare Diagnoses
- Amyloidosis: This condition can involve multiple systems, including the respiratory system, and could potentially explain some of the patient's symptoms, although it is much less common.
- Hemochromatosis: Although more commonly associated with liver disease and skin pigmentation, hemochromatosis can lead to pulmonary symptoms and might explain some of the patient's findings, especially if there's a family history or other suggestive signs.
- Lymphoma: Given the patient's autoimmune background, there's a slightly increased risk of lymphoma, which can cause a wide range of symptoms including dry eyes, dry mouth, and respiratory issues.