The great imitator

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The Great Imitator (also the Great Masquerader) is a phrase used for medical conditions that feature nonspecific symptoms and may be confused with a number of other diseases. [1] The term connotes especially difficult differential diagnosis (DDx), especial potential for misdiagnosis, and the protean nature of some diseases. Most great imitators are systemic in nature or have systemic sequelae, and an aspect of nonspecific symptoms is logically almost always involved. In some cases, an assumption that a particular sign or symptom, or a particular pattern of several thereof, is pathognomonic turns out to be false, as the reality is that it is only nearly so.

Contents

As recently as the 1950s, syphilis was widely considered by physicians to be "the great imitator", and in the next few decades after that, several other candidates, mainly tuberculosis [2] but occasionally others, [3] were asserted as being "the second great imitator". But because differential diagnosis is inherently subject to occasional difficulty and to false positives and false negatives, the idea that there are only one or two great imitators was more melodrama than objective description. In recent decades, more than a dozen diseases have been recognized in the medical literature as worthy of being considered great imitators, on the common theme of recurring misdiagnoses/missed diagnoses and protean manifestations. Nonetheless, not every DDx caveat (not every mimic) meets the threshold, because it is inherent to DDx generally that there are thousands of caveats (thousands of instances of the theme, "be careful to rule out X before diagnosing Y"); for example, ectopic pregnancy and ovarian neoplasia can mimic each other, as can myocardial infarction and panic attack, but they are not established as great imitators per se (rather, merely DDx considerations). The list of great imitators here relies on references in the medical literature applying that label, or on other references documenting a condition's especially recurrent and poignant reputation for misdiagnoses.

Conditions or diseases sometimes referred to with this nickname thus include the following:

Low blood sugar

Tumors (neoplasms), especially cancerous tumors or any endocrine tumors

Vitamin deficiency

Substance abuse

Rheumatic diseases (most with autoimmune components)

Dysplastic diseases, some with precancerous or rheumatologic aspects

Neurologic disorders

Gut diseases

Abdominal inflammations or their mimics

Endocrine disorders

Thromboembolic events or their mimics

Infectious diseases

Proteinopathies

Mass effect inside the cranium

Skin conditions

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  2. nodules, i.e. small firm lumps usually >0.1 cm in diameter; and/or
  3. tumors, i.e. masses often regarded as ~0.8 cm or larger.
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Genital leiomyomas are leiomyomas that originate in the dartos muscles, or smooth muscles, of the genitalia, areola, and nipple. They are a subtype of cutaneous leiomyomas that affect smooth muscle found in the scrotum, labia, or nipple. They are benign tumors, but may cause pain and discomfort to patients. Genital leiomyoma can be symptomatic or asymptomatic and is dependent on the type of leiomyoma. In most cases, pain in the affected area or region is most common. For vaginal leiomyoma, vaginal bleeding and pain may occur. Uterine leiomyoma may exhibit pain in the area as well as painful bowel movement and/or sexual intercourse. Nipple pain, enlargement, and tenderness can be a symptom of nipple-areolar leiomyomas. Genital leiomyomas can be caused by multiple factors, one can be genetic mutations that affect hormones such as estrogen and progesterone. Moreover, risk factors to the development of genital leiomyomas include age, race, and gender. Ultrasound and imaging procedures are used to diagnose genital leiomyomas, while surgically removing the tumor is the most common treatment of these diseases. Case studies for nipple areolar, scrotal, and uterine leiomyoma were used, since there were not enough secondary resources to provide more evidence.

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References

  1. ↑ J.C. Segen. The Dictionary of Modern Medicine . CRC Press; 1992. ISBN   978-1-85070-321-1. p. 265.
  2. 1 2 3 Sievers, Maurice L. (3 June 1961). "The Second "Great Imitator"—Tuberculosis". JAMA. 176 (9): 809–810. doi:10.1001/JAMA.1961.63040220009017A.
  3. 1 2 Froede, RC; Gordon, JD (November 1980). "Alcoholism--the second great imitator. An introduction to the problem of alcoholism". American Journal of Clinical Pathology. 74 (5): 719–20. doi:10.1093/ajcp/74.5.719. PMID   7004168.
  4. 1 2 Hosseininezhad, M; Sohrabnejad, R (2017). "Stroke mimics in patients with clinical signs of stroke". Caspian Journal of Internal Medicine. 8 (3): 213–216. doi:10.22088/cjim.8.3.213. PMC   5596193 . PMID   28932374.
  5. ↑ Kufe, Donald W. (2009). Holland-Frei cancer medicine (8th ed.). New York: McGraw-Hill Medical. pp. 1–3. ISBN   978-1-60795-014-1.
  6. ↑ Del Paggio, Joseph; et al. (2017). "Disturbances in blood flow and 'medicine's greatest imitator'". Internal Medicine Journal. 47 (5): 586–588. doi:10.1111/imj.13414. PMID   28503874. S2CID   3799976.
  7. ↑ Hodak, E; Amitay-Laish, I (2019-05-01). "Mycosis fungoides: a great imitator". Clinics in Dermatology. 37 (3): 255–267. doi:10.1016/j.clindermatol.2019.01.004. PMID   31178107. S2CID   81927761.
  8. ↑ Jaros, J; Hunt, S; Mose, E; Lai, O; Tsoukas, M (2020-03-01). "Cutaneous metastases: a great imitator". Clinics in Dermatology. 38 (2): 216–222. doi:10.1016/j.clindermatol.2019.10.004. PMID   32513401. S2CID   208446382.
  9. ↑ Kellerman, Rick D.; Rakel, David (2018-12-06). Conn's Current Therapy 2019. Elsevier Health Sciences. p. 971. ISBN   978-0-323-59650-3. Oral cancer has been called the great imitator, for it can appear as many different oral conditions.
  10. 1 2 Boodman, Sandra G. (17 December 2022). "Her crippling digestive problems were caused by a 'zebra' malady [pNETs]". Washington Post. Retrieved 2022-12-18.
  11. ↑ Guermazi, Ali (2005-10-05). Imaging of Kidney Cancer. Springer Science & Business Media. p. 104. ISBN   978-3-540-21129-7. Because of its protean and often nonspecific clinical manifestation, RCC is sometimes referred to as the 'great imitator' by clinicians.
  12. 1 2 Lonsdale, Derrick (2017). Thiamine deficiency disease, dysautonomia, and high calorie malnutrition. London, United Kingdom: Academic Press. ISBN   9780128103883.
  13. 1 2 Lonsdale, Derrick (2015-11-04). "Beriberi, the Great Imitator". Hormones Matter. CRM Health and Fitness. Retrieved 2022-02-14.
  14. ↑ Qazimllari, Blerta. "VITAMIN B12 DEFICIENCY: A GREAT MIMICKER" (PDF). Archived (PDF) from the original on 2024-01-26. Retrieved 2024-01-25.
  15. ↑ Wolffenbuttel, Bruce HR; Owen, P. Julian; Ward, Mary; Green, Ralph (2023-11-20). "Vitamin B12". BMJ. 383: e071725. doi:10.1136/bmj-2022-071725. ISSN   1756-1833. PMID   37984968.
  16. ↑ Fatemi, S. Hossein; Clayton, Paula J. (2016-03-17). The Medical Basis of Psychiatry. Springer. p. 281. ISBN   978-1-4939-2528-5. Substance abuse has been called the "great imitator" of our time for good reason.
  17. ↑ Fibromyalgia as the great imitator, retrieved December 16th, 2006
  18. ↑ "Psoriatic arthritis". 29 Jan 2017.
  19. ↑ "Right Care". 12 June 2014.
  20. ↑ Bell, JM; Nair, R; Solon, A; Walker, PD (2005). "SLE: The great imitator strikes again". American Journal of Kidney Diseases. 45 (1): 219–22. doi:10.1053/j.ajkd.2004.05.049. PMID   15696465.
  21. ↑ Rooney, J (2005). "Systemic lupus erythematosus: Unmasking a great imitator". Nursing. 35 (11): 54–60, quiz 60–61. CiteSeerX   10.1.1.1008.5428 . doi:10.1097/00152193-200511000-00049. PMID   16280927.
  22. ↑ Wolfe, Scott W.; Pederson, William C.; Kozin, Scott H.; Cohen, Mark S. (2016-02-24). Green's Operative Hand Surgery. Elsevier Health Sciences. p. 1905. ISBN   978-0-323-29534-5. Often called "the great imitator," gout may masquerade as septic arthritis, RA, or neoplasm, and the diagnosis is often delayed by weeks or months.
  23. ↑ Karadağ, AS; Parish, LC (2019-05-01). "Sarcoidosis: a great imitator". Clinics in Dermatology. 37 (3): 240–254. doi:10.1016/j.clindermatol.2019.01.005. PMID   31178106. S2CID   81361928.
  24. ↑ Tchernev, G (2006). "Cutaneous sarcoidosis: The 'great imitator': Etiopathogenesis, morphology, differential diagnosis, and clinical management". American Journal of Clinical Dermatology. 7 (6): 375–82. doi:10.2165/00128071-200607060-00006. PMID   17173472. S2CID   12854713.
  25. ↑ Culley, L; Law, C; Hudson, N; Denny, E; Mitchell, H; Baumgarten, M; Raine-Fenning, N (November 2013). "The social and psychological impact of endometriosis on women's lives: a critical narrative review". Human Reproduction Update. 19 (6): 625–39. doi: 10.1093/humupd/dmt027 . hdl: 2086/8845 . PMID   23884896.
  26. ↑ Gross, Rachel E. (2021-04-28) [2021-04-27]. "They Call It a 'Women's Disease.' She Wants to Redefine It. Profiles in Science feature". The New York Times. Archived from the original on 2021-04-29. Retrieved 2022-02-14. Discusses endometriosis, including the themes of misdiagnosis and poor medical understanding as traditionally long-standing problems in this disease.{{cite web}}: CS1 maint: postscript (link)
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  28. ↑ Woods, William (1 January 2004). "Coeliac disease: the great imitator". Med. J. Aust. 181 (7): 371. doi:10.5694/j.1326-5377.2004.tb06331.x. PMID   15462655. S2CID   31629803 – via eMJA.
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  30. ↑ Thompson, JP; Selvaraj, D; Nicola, R (2014). "Mimickers of acute appendicitis". J Am Osteopath Coll Radiol. 3 (4): 10–21. Retrieved 2022-02-11.
  31. ↑ Williams, Penny; Evans, Sorcha; Thachil, Jecko (2010). "The Great Imitator". The American Journal of Medicine. 123 (7): e5. doi:10.1016/j.amjmed.2009.12.027. PMID   20609673.
  32. ↑ Kopp, SA; et al. (2010). "Cutaneous manifestations of hypothyroidism". In Heymann, Warren R. (ed.). Thyroid disorders with cutaneous manifestations. London: Springer Science and Business Media. ISBN   9781848001879.
  33. ↑ Sharma, GV; Sasahara, AA; McIntyre, KM (1976). "Pulmonary embolism: The great imitator". Disease-a-Month. 22 (7): 4–38. doi:10.1016/s0011-5029(76)80005-3. PMID   770102.
  34. ↑ Moulin, S; Leys, D (February 2019). "Stroke mimics and chameleons". Current Opinion in Neurology. 32 (1): 54–59. doi:10.1097/WCO.0000000000000620. PMID   30239360. S2CID   52306962.
  35. ↑ Vilela, P (November 2017). "Acute stroke differential diagnosis: Stroke mimics". European Journal of Radiology. 96: 133–144. doi:10.1016/j.ejrad.2017.05.008. PMID   28551302.
  36. ↑ Çakmak, SK; Tamer, E; Karadağ, AS; Waugh, M (2019-05-01). "Syphilis: a great imitator". Clinics in Dermatology. 37 (3): 182–191. doi:10.1016/j.clindermatol.2019.01.007. PMID   31178101. S2CID   80733004.
  37. ↑ Keuning, MW; Kamp, GA; Schonenberg-Meinema, D; Dorigo-Zetsma, JW; van Zuiden, JM; Pajkrt, D (July 2020). "Congenital syphilis, the great imitator—case report and review". The Lancet. Infectious Diseases. 20 (7): e173–e179. doi:10.1016/S1473-3099(20)30268-1. PMID   32502432. S2CID   219398876.
  38. ↑ "STD Facts - Syphilis". 2017-12-11.
  39. ↑ Pachner, AR (September 1989). "Neurologic manifestations of Lyme disease, the new "great imitator"". Reviews of Infectious Diseases. 11 Suppl 6: S1482-6. doi:10.1093/clinids/11.Supplement_6.S1482. PMID   2682960.
  40. ↑ Stechenberg, BW (June 1988). "Lyme disease: the latest great imitator". The Pediatric Infectious Disease Journal. 7 (6): 402–9. doi:10.1097/00006454-198806000-00007. PMID   3292999. S2CID   45395427.
  41. 1 2 Melia, MT; Lantos, PM; Auwaerter, PG (October 2014). "Lyme disease: authentic imitator or wishful imitation?". JAMA Neurology. 71 (10): 1209–10. doi:10.1001/jamaneurol.2014.1193. PMC   4331047 . PMID   25090401.
  42. ↑ Lederman, Edith R.; Crum, Nancy F. (2004). "A Case Series and Focused Review of Nocardiosis". Medicine. 83 (5): 300–13. doi: 10.1097/01.md.0000141100.30871.39 . PMID   15342974. S2CID   23940448.
  43. ↑ Chen, Q; Chen, W; Hao, F (2019-05-01). "Cutaneous tuberculosis: a great imitator". Clinics in Dermatology. 37 (3): 192–199. doi:10.1016/j.clindermatol.2019.01.008. PMID   31178102. S2CID   80862366.
  44. ↑ http://www.malariasite.com/clinical-features.htm%5B%5D
  45. ↑ Kundakci, N; Erdem, C (2019-05-01). "Leprosy: a great imitator". Clinics in Dermatology. 37 (3): 200–212. doi:10.1016/j.clindermatol.2019.01.002. PMID   31178103. S2CID   80817680.
  46. ↑ Gurel, MS; Tekin, B; Uzun, S (2020-03-01). "Cutaneous leishmaniasis: a great imitator". Clinics in Dermatology. 38 (2): 140–151. doi:10.1016/j.clindermatol.2019.10.008. PMID   32513395. S2CID   201965975.
  47. ↑ Knöpfel, N; Noguera-Morel, L; Latour, I; Torrelo, A (2019-05-01). "Viral exanthems in children: a great imitator". Clinics in Dermatology. 37 (3): 213–226. doi:10.1016/j.clindermatol.2019.01.009. PMID   31178104. S2CID   81488794.
  48. ↑ Bieber, Eric J.; Sanfilippo, Joseph S.; Horowitz, Ira R.; Shafi, Mahmood I. (2015-04-23). Clinical Gynecology. Cambridge University Press. p. 341. ISBN   978-1-107-04039-7. Scabies is called the great imitator because patients can present with a variety of lesions.
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