What is the differential diagnosis for a 72-year-old male presenting with generalized limb and back pain, with no chest or facial pain, who had normal Emergency Room (ER) imaging 3 days ago, after initially suspecting a stroke (cerebrovascular accident)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 13, 2025 • View editorial policy

Differential Diagnosis for 72-year-old Male with Generalized Pain

Single Most Likely Diagnosis

  • Polymyalgia Rheumatica (PMR): This condition is characterized by aching and stiffness in the neck, shoulder, and hip areas, which matches the patient's symptoms of generalized pain mainly in the limbs and back. The absence of chest pain or facial pain and full strength in all extremities also supports this diagnosis.

Other Likely Diagnoses

  • Fibromyalgia: A chronic condition that causes widespread muscle pain, fatigue, and tenderness, which could explain the patient's generalized pain.
  • Osteoarthritis: A common condition in older adults that causes joint pain and stiffness, potentially leading to generalized pain if multiple joints are involved.
  • Hypothyroidism: Can cause muscle aches, stiffness, and pain, which might be generalized and could fit the patient's symptoms.

Do Not Miss Diagnoses

  • Multiple Myeloma: A type of blood cancer that can cause bone pain, which might be perceived as generalized pain. It's crucial to consider this diagnosis due to its severity and the need for prompt treatment.
  • Metastatic Cancer: Cancer that has spread to bones can cause generalized pain and should be considered, especially in an older adult.
  • Vasculitis: Inflammation of the blood vessels can cause a variety of symptoms, including pain, and some forms can be life-threatening if not treated promptly.

Rare Diagnoses

  • Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues, which can cause widespread pain.
  • Sarcoidosis: An inflammatory disease that can affect multiple parts of the body, including the bones and joints, leading to pain.
  • Amyloidosis: A condition caused by an abnormal protein (amyloid) that can accumulate in various organs, including bones and joints, leading to pain.

Each of these diagnoses has a brief justification based on the patient's symptoms and the need for a comprehensive differential diagnosis to ensure that potentially serious conditions are not overlooked.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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