Differential Diagnosis
- Single most likely diagnosis
- Scleroderma (Systemic Sclerosis): This condition is characterized by fibrosis and thickening of the skin and internal organs. The patient's symptoms, including esophageal stricture requiring dilation and a history of MGUS (Monoclonal Gammopathy of Undetermined Significance), could be related to scleroderma. De Quervain's tenosynovitis and chillblains can also be seen in this disease.
- Other Likely diagnoses
- Rheumatoid Arthritis: This autoimmune disorder can cause tenosynovitis, and some patients may experience esophageal symptoms. However, the combination of esophageal stricture and MGUS history makes scleroderma more likely.
- Mixed Connective Tissue Disease: This condition overlaps with scleroderma, rheumatoid arthritis, and lupus, and could potentially explain the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Multiple Myeloma: Given the patient's history of MGUS, there is a risk of progression to multiple myeloma, which would require prompt diagnosis and treatment.
- Amyloidosis: This condition can cause esophageal strictures and is associated with MGUS. It would be critical to rule out amyloidosis due to its potential for serious complications.
- Rare diagnoses
- Eosinophilic Esophagitis: This condition could cause esophageal stricture, but it would not explain the patient's other symptoms, such as De Quervain's tenosynovitis and chillblains.
- Relapsing Polychondritis: This rare autoimmune disorder can cause a range of symptoms, including esophageal strictures and tenosynovitis. However, it would be a less likely diagnosis given the patient's overall clinical presentation.