Docs Ask AI: Orbital Myositis, Nephrotic Syndrome, and Retroperitoneal Fibrosis. What's the Diagnosis?

The "Docs Ask AI" series features clinical Q&A sessions with four distinct AIs, showcasing their unique personalities, accuracy, and writing styles. 

This series is designed to provide valuable insights into the potential clinical usefulness of AIs in the field of medicine. By showcasing the strengths and weaknesses of each AI, medical professionals can gain a better understanding of how these technologies can assist with clinical and administrative tasks. Additionally, this information can help physicians determine which AI may be the best fit for their specific needs and preferences.

(Introduction by Doximity's DocsGPT.)

Prompt:

"What's the most likely diagnosis when a patient has orbital myositis, retroperitoneal fibrosis, and nephrotic syndrome?"

Answer:

"IgG4-related disease."

Correct answers were provided by Claude+, GPT-4, and Doximity's DocsGPT.

Here's what Claude+, GPT-4, Doximity's DocsGPT, and Google's Bard said:

Claude+:

The combination of orbital myositis, retroperitoneal fibrosis, and nephrotic syndrome would be highly suggestive of IgG4-related disease. This is an autoimmune fibrosing condition that can affect multiple organs. The common features in this case would be:

- Orbital myositis causing inflammation of extraocular muscles leading to eye pain, swelling, and impaired eye movement. 

- Retroperitoneal fibrosis leading to inflammation and scarring in the tissues behind the peritoneum, causing ureteric obstruction and hydronephrosis.

- Nephrotic syndrome causing high protein loss in the urine due to inflammation of the kidneys (IgG4-related kidney disease).

IgG4-related disease would be the top differential diagnosis requiring confirmation with biopsy and immunohistochemistry to show characteristic IgG4-positive plasma cell infiltration. Treatment involves use of corticosteroids to suppress the autoimmune inflammation, and immunosuppressants like azathioprine or rituximab in refractory cases.

The other but less likely differentials could include sarcoidosis, lymphoma, multifocal fibrosclerosis, and periaortitis. But the combination of features in this case strongly suggests IgG4-related systemic disease as the most probable diagnosis.

So in summary, the most likely diagnosis would be IgG4-related disease - a systemic autoimmune fibrosing condition involving multiple organs. Diagnosis needs to be confirmed on biopsy, and treatment focuses on immunosuppression.

GPT-4:

I'm not a doctor, but I can try to provide you with some information. Orbital myositis, retroperitoneal fibrosis, and nephrotic syndrome are all inflammatory conditions that can have various etiologies. One possible diagnosis that could present with these symptoms is a systemic autoimmune or inflammatory disorder such as systemic lupus erythematosus (SLE), granulomatosis with polyangiitis (GPA, formerly known as Wegener's granulomatosis), or IgG4-related disease.

IgG4-related disease is a relatively rare immune-mediated condition characterized by tumefactive lesions, dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, and storiform fibrosis. It can affect various organs, including the orbit (orbital myositis), retroperitoneum (retroperitoneal fibrosis), and kidneys (nephrotic syndrome). This disease could potentially explain the combination of symptoms you're describing.

However, it's important to note that a proper diagnosis can only be made by a healthcare professional after a thorough evaluation of the patient's medical history, physical examination, laboratory tests, and imaging studies. If you or someone you know is experiencing these symptoms, it's crucial to consult a medical professional for an accurate diagnosis and appropriate management.

Doximity's DocsGPT:

The most likely diagnosis in a patient with orbital myositis, retroperitoneal fibrosis, and nephrotic syndrome is IgG4-related disease. This is a rare autoimmune disorder that can affect multiple organs in the body, including the kidneys, pancreas, salivary glands, lymph nodes, and others. It is characterized by high levels of IgG4 antibodies and infiltration of affected tissues by IgG4-positive plasma cells. Treatment typically involves corticosteroids and immunosuppressive medications. It is important to consult with a specialist in rheumatology and/or nephrology for proper diagnosis and management of this condition.

Google's Bard:

The most likely diagnosis when a patient has orbital myositis, retroperitoneal fibrosis, and nephrotic syndrome is idiopathic retroperitoneal fibrosis (IPF). IPF is a rare, chronic inflammatory disease that causes the growth of fibrous tissue in the retroperitoneum, the area behind the peritoneum, the lining of the abdominal cavity. The fibrous tissue can block the ureters, the tubes that carry urine from the kidneys to the bladder, leading to nephrotic syndrome. IPF is also associated with orbital myositis, an inflammation of the muscles around the eye.

The exact cause of IPF is unknown, but it is thought to be an autoimmune disorder. Autoimmune disorders occur when the body's immune system attacks healthy tissue. In the case of IPF, the immune system attacks the tissues in the retroperitoneum.

The symptoms of IPF vary from person to person, but they may include:

• Pain in the lower back or abdomen
• Fatigue
• Weight loss
• High blood pressure
• Protein in the urine
• Edema, or swelling, in the legs, ankles, and feet

If you have any of these symptoms, it is important to see a doctor to get a diagnosis and treatment. There is no cure for IPF, but treatment can help to relieve symptoms and improve quality of life. Treatment options may include:

• Medications to suppress the immune system
• Surgery to remove the fibrous tissue
• Dialysis, if the kidneys have failed

With treatment, most people with IPF can live a normal life.