Differential Diagnosis for Ivan's Symptoms
- Single Most Likely Diagnosis
- Pneumonia: Ivan's symptoms of cough, body aches, fevers, and productive sputum with a change in color (maroon, brown) are consistent with pneumonia. The mid-thoracic back pain that worsens with coughing also suggests a pulmonary origin, possibly indicating a lower lobe pneumonia that is irritating the diaphragm and referring pain to the back.
- Other Likely Diagnoses
- Bronchitis: Given Ivan's history of asthma and exposure to irritants like secondhand smoke and burnt wood, chronic bronchitis could be a consideration, especially with his productive cough and fatigue.
- Pulmonary Embolism (PE): Although Ivan denies shortness of breath, the presence of significant back pain (worsening with coughing) and recent weight loss could raise suspicion for a PE, especially in the context of possible decreased mobility due to excessive daytime sleepiness.
- Sleep Apnea Exacerbation: Ivan's non-functioning CPAP machine and resultant excessive daytime sleepiness could exacerbate underlying respiratory issues, contributing to his current state.
- Do Not Miss Diagnoses
- Tuberculosis (TB): Despite Ivan's denial of known recent exposure to TB and lack of recent travel, his symptoms of night sweats, weight loss, and productive cough with colored sputum necessitate consideration of TB, especially given his country of origin.
- Lung Cancer: Ivan's history of smoking (even if minimal), significant weight loss, and night sweats warrant consideration of lung cancer, although this would be less likely given his age and relatively short smoking history.
- Rare Diagnoses
- Histoplasmosis or Coccidioidomycosis: These fungal infections could present with similar symptoms, including cough, fever, and weight loss, especially in individuals from certain geographic regions (e.g., Mexico for Coccidioidomycosis).
- Sarcoidosis: This condition can cause pulmonary symptoms, fatigue, and weight loss, but it would be less likely without other systemic symptoms or findings suggestive of sarcoidosis.