Differential Diagnosis for 38F with Dry Eyes, Dry Mouth, and Nocturnal SOB
- Single Most Likely Diagnosis
- Sjögren's Syndrome: Given the patient's symptoms of dry eyes and dry mouth, along with a history of autoimmune conditions (psoriasis and celiac disease), Sjögren's Syndrome is a strong consideration. This autoimmune disorder often presents with sicca symptoms (dry eyes and mouth) and can be associated with other systemic symptoms.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GORD) exacerbation: Despite a previous trial of PPI with minimal effect, GORD can still be a contributing factor, especially if the patient has not been fully compliant or if the dose was insufficient. Nocturnal symptoms could be worsened by lying down.
- Anxiety or Panic Disorder: The patient's description of feeling "amnesic" and "can't breathe enough O2" at night, along with insomnia, could suggest an anxiety or panic disorder. These conditions can manifest with significant respiratory symptoms, especially at night.
- Sleep Apnea: Although less directly linked to the patient's other symptoms, sleep apnea could explain the nocturnal shortness of breath and is a common condition that should be considered, especially given the patient's report of symptoms worsening at night.
- Do Not Miss Diagnoses
- Pulmonary Embolism: Although the patient had a normal ECG and CXR, and the symptoms have been ongoing for 2 months, it's crucial not to miss a pulmonary embolism, especially if there are any signs of deep vein thrombosis or if the patient has risk factors for thromboembolic events.
- Cardiac Conditions (e.g., Heart Failure): Unexplained nocturnal shortness of breath could be a sign of heart failure or other cardiac conditions. A normal ECG does not rule out all cardiac issues, and further evaluation might be necessary.
- Rare Diagnoses
- Hyperventilation Syndrome: This condition involves rapid and deep breathing, which can lead to feelings of not being able to breathe enough oxygen. It's often associated with anxiety but can be a standalone diagnosis.
- Vocal Cord Dysfunction: This rare condition can mimic asthma or other respiratory diseases, causing shortness of breath and can be exacerbated by stress or environmental factors.
- Environmental or Allergic Causes: Given the patient's suspicion of an environmental or allergic cause, considering rare conditions such as hypersensitivity pneumonitis or other occupational lung diseases might be warranted, especially if the patient has a specific exposure history.