Differential Diagnosis
- Single most likely diagnosis
- Viral infection: The patient's symptoms of progressively worsening dyspnea, bilateral pitting ankle edema, and small bilateral pleural effusions, along with the absence of chest pain, skin rash, or joint pain, suggest a possible viral infection leading to myocarditis or pericarditis, which can cause heart failure. The recent travel history and the onset of symptoms after returning from vacation support this diagnosis.
- Other Likely diagnoses
- Connective tissue disease: Although the patient does not have joint pain or skin rash, some connective tissue diseases like systemic lupus erythematosus (SLE) can present with cardiac involvement, including myocarditis or pericarditis, leading to heart failure.
- Coccidioidomycosis: Given the patient's travel history to Texas, where Coccidioidomycosis is endemic, this fungal infection could be a possible cause of her symptoms, particularly if she has developed pulmonary or disseminated disease affecting the heart.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lyme disease: Although less common, Lyme disease can cause cardiac manifestations, including myocarditis or heart block, and should be considered in the differential diagnosis, especially given the patient's active lifestyle and potential exposure to ticks.
- Hypothyroidism: Severe, untreated hypothyroidism can lead to pericardial effusion and heart failure, making it a crucial diagnosis not to miss, despite its lower likelihood.
- Rare diagnoses
- Atherosclerosis: Given the patient's age and lack of risk factors, atherosclerosis is an unlikely cause of her symptoms, but it should be considered in the broader differential diagnosis.
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): This rare condition can cause cardiac involvement, including myocarditis or pericarditis, but it is typically associated with asthma, eosinophilia, and other systemic symptoms, making it a less likely diagnosis in this case.