Differential Diagnosis for a 13-year-old boy with paroxysmal thoracic pain and "achy joints"
- Single most likely diagnosis:
- Familial Mediterranean Fever (FMF) or more likely Viral Pericarditis given the symptoms of paroxysmal thoracic pain aggravated by deep breathing, coughing, or movement, and a recent similar experience in a family member. However, the most common cause of such symptoms, especially with the additional complaint of "achy joints," could be related to a viral infection.
- Other Likely diagnoses:
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause sharp pains in the chest that worsen with deep breathing or coughing.
- Viral Pleurisy: Inflammation of the pleura (the two-layered membrane surrounding the lungs) due to a viral infection, which can cause chest pain that worsens with breathing or coughing.
- Myopericarditis: Inflammation of both the heart muscle (myocardium) and the membrane surrounding the heart (pericardium), often due to a viral infection, which can cause chest pain and "achy joints."
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary Embolism: Although rare in children, it's a life-threatening condition that requires immediate attention. The risk factors and presentation might be different in pediatric patients.
- Pneumonia: Especially if caused by a bacterium, it can lead to severe complications if not treated promptly.
- Acute Coronary Syndrome: Though extremely rare in children, any condition affecting the coronary arteries could lead to severe outcomes.
- Rare diagnoses:
- Sickle Cell Crisis: If the patient has sickle cell disease, a crisis could cause severe pain, including chest pain.
- Tietze's Syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, which can cause severe chest pain.
- Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilage in various parts of the body, including the ribs, leading to chest pain.
The viruses that could cause these conditions include Coxsackievirus (for viral pericarditis or myocarditis), influenza, and other respiratory viruses that could lead to secondary infections like pneumonia or viral pleurisy. The recent similar experience in a family member might suggest a familial or infectious etiology, but without more specific information, pinpointing the exact virus is challenging.