Differential Diagnosis
- Single most likely diagnosis
- Anaphylaxis: The patient's symptoms of bilateral hand redness, itching, swelling, dizziness, double vision, diaphoresis, and incontinence of urine after taking Naprosyn suggest an allergic reaction. Although the patient denies any history of allergies to Naprosyn, anaphylaxis can occur even with previous exposure to a medication. The presence of systemic symptoms and the rapid onset after medication ingestion support this diagnosis.
- Other Likely diagnoses
- Angioedema: This condition is characterized by rapid swelling of the skin and mucous membranes, which could explain the patient's hand swelling and redness. However, the presence of systemic symptoms such as dizziness and double vision makes anaphylaxis more likely.
- Medication-induced hypersensitivity reaction: This is a broader category that includes anaphylaxis and other types of allergic reactions. The patient's symptoms are consistent with a hypersensitivity reaction to Naprosyn.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial infarction: Although the patient denies chest pain, the EKG changes (1st degree AV block and frequent PVCs) could be indicative of cardiac ischemia. Myocardial infarction is a life-threatening condition that requires prompt diagnosis and treatment.
- Stroke or transient ischemic attack (TIA): The patient's symptoms of double vision and dizziness could be indicative of a stroke or TIA. Although the neuro exam is benign, it is essential to consider these possibilities due to the potential for severe consequences if missed.
- Rare diagnoses
- Serum sickness-like reaction: This is a rare condition that can occur after medication exposure, characterized by symptoms such as rash, fever, and arthralgias. Although the patient's symptoms do not entirely fit this diagnosis, it is a possibility to consider.
- Pseudoporphyria: This is a rare condition that can be induced by certain medications, including NSAIDs like Naprosyn. It is characterized by skin blistering and fragility, which is not consistent with the patient's symptoms. However, it is a rare diagnosis to consider in the differential.