Differential Diagnosis
The patient's symptoms of De Quervain's tenosynovitis, chillblains, and esophageal stricture requiring dilation in a 72-year-old female can be approached by considering the following categories:
Single Most Likely Diagnosis
- Rheumatoid Arthritis (RA): This condition can cause De Quervain's tenosynovitis and esophageal stricture due to chronic inflammation. Chillblains can also occur in the context of RA due to vasculitis or Raynaud's phenomenon, which can be associated with RA.
Other Likely Diagnoses
- Systemic Sclerosis (Scleroderma): This autoimmune disease can lead to esophageal strictures due to fibrosis and can also cause Raynaud's phenomenon, which might explain the chillblains. De Quervain's tenosynovitis could be related to the systemic inflammation.
- Mixed Connective Tissue Disease (MCTD): Overlapping features of RA, scleroderma, and lupus can explain the combination of symptoms, including musculoskeletal, gastrointestinal, and vascular manifestations.
Do Not Miss Diagnoses
- Lupus: Systemic lupus erythematosus (SLE) can cause a wide range of symptoms, including musculoskeletal issues like De Quervain's tenosynovitis, vasculitis leading to chillblains, and gastrointestinal involvement. Missing lupus could lead to significant morbidity and mortality if not treated promptly.
- Sjögren's Syndrome: While primarily known for causing dry eyes and mouth, Sjögren's can also lead to systemic manifestations, including musculoskeletal symptoms and potentially esophageal involvement. It's crucial not to miss this diagnosis due to its potential for systemic complications.
Rare Diagnoses
- Ehlers-Danlos Syndrome: Certain types of Ehlers-Danlos syndrome can lead to gastrointestinal and musculoskeletal manifestations, including potentially esophageal strictures and joint hypermobility issues that might mimic De Quervain's tenosynovitis. However, the age of onset and specific combination of symptoms make this a less likely consideration.
- Relapsing Polychondritis: This rare autoimmune disorder can affect cartilaginous structures throughout the body, potentially leading to esophageal and musculoskeletal symptoms. However, its rarity and the specific constellation of symptoms presented make it a less likely diagnosis.