Lethal kniest-like dysplasia is a very rare genetic bone disorder that affects growth before birth. Early signs of Lethal kniest-like dysplasia often include very short arms and legs, a small chest, and other severe skeletal features seen on prenatal ultrasound or at birth. It is usually recognized before birth, in the newborn period, or both, and the pattern is present from the start of life. Lethal kniest-like dysplasia is called lethal because many affected babies die before birth or soon after delivery, usually because the chest and lungs cannot support breathing well enough. Treatment does not cure the condition, so care focuses on comfort, breathing support when appropriate, and support for the family.
How many people live with Lethal kniest-like dysplasia?
Reliable worldwide and U.S. estimates for how many people live with lethal Kniest-like dysplasia are not consistently reported by a single authoritative source. This condition appears to be extraordinarily rare and is usually fatal before or shortly after birth, so only a very small number of cases have been described and no dependable global or U.S. living population count is available.
Overview
Lethal kniest-like dysplasiaSymptoms
Lethal Kniest-like dysplasia causes severe short limbs, a very small chest, and distinctive facial features. These signs are usually seen before birth or at delivery, and the small chest often leads to critical breathing problems.
Outlook and prognosis
Lethal Kniest-like dysplasia is a very severe bone disorder. Many affected babies die before birth or soon after delivery because the chest is too small for the lungs to work properly. Families often need intensive pregnancy and newborn support.
Causes and risk factors
Lethal Kniest-like dysplasia is usually caused by a new change in a collagen gene, most often COL2A1. It is typically not inherited, though a parent with the variant could pass it on. Lifestyle or environmental factors are not primary causes.
Genetic influences
Genetics are central to lethal Kniest-like dysplasia, which is caused by harmful changes in genes involved in building cartilage and bone. These genetic variations disrupt early skeletal development and are the main reason the condition occurs.
Diagnosis
Lethal kniest-like dysplasia is usually suspected before or at birth from clinical features and imaging findings showing severe skeletal changes. The diagnosis of Lethal kniest-like dysplasia is confirmed with genetic tests when possible.
Treatment and drugs
Treatment for Lethal kniest-like dysplasia focuses on comfort and supportive care, especially around breathing and feeding after birth. Many families are also offered palliative care and genetic counseling to help with decisions, planning, and support.
Symptoms
Lethal kniest-like dysplasia is usually noticed during pregnancy or at birth because the bones, chest, and body proportions develop very differently from usual. The early features of Lethal kniest-like dysplasia often include very short arms and legs, a short trunk, and a very small chest, which can make breathing hard right away. Many living with this condition are affected so severely before or around birth that survival is very limited. Symptoms vary from person to person and can change over time.
The arms and legs are much shorter than expected for the baby's stage of growth. This difference is often obvious on prenatal ultrasound or at birth.
The chest may be very narrow and short, leaving less room for the lungs to grow. Day to day, it can feel like breathing is the central problem from the start, and many affected babies have severe respiratory distress.
The body may look compact with a shortened trunk and unusual body proportions. The abdomen can seem more prominent because the chest and trunk are so small.
Large joints may look enlarged or puffy, and the arms or legs can appear broad near the ends of the bones. These changes reflect abnormal bone and cartilage growth rather than injury or swelling from infection.
How people usually first notice Lethal kniest-like dysplasia?
Lethal kniest-like dysplasia is usually first noticed before birth or at delivery, when ultrasound or the newborn exam shows very short limbs, a narrow chest, and other severe bone growth differences. In many pregnancies, the first signs of lethal kniest-like dysplasia are poor growth, unusually short arms and legs, and skeletal changes that make doctors worry the lungs may not have enough room to develop normally. After birth, babies are typically recognized as being very seriously affected right away because of marked short stature, distinctive body proportions, and life-threatening breathing problems linked to the small chest.
Types of Lethal kniest-like dysplasia
No distinct types of Lethal kniest-like dysplasia are widely recognized.
Can I slow down the onset of symptoms?
No. For lethal kniest-like dysplasia, this very rare genetic bone growth condition starts before birth, and there is no good evidence that lifestyle changes or medical treatment can meaningfully delay when symptoms begin. Things like diet, exercise, sleep, or supplements have not been shown to slow or prevent its onset, and care is mainly focused on pregnancy monitoring, planning for delivery and newborn support, and talking with a genetics specialist about future pregnancy risk; while this cannot stop the condition from starting, it can still help families prepare and understand their options.
What genetics can tell you about symptoms
In lethal Kniest-like dysplasia, genetics can help confirm that the condition is caused by a change affecting how cartilage and bone develop, which is why the main features are usually severe shortening of the limbs, very small stature, and a small chest that can lead to serious breathing problems before or around birth. For many living with related skeletal dysplasias, the exact genetic change may give some clues about how severe the bone changes are, but this condition is so rare that genetics usually cannot predict every symptom or its exact timing with certainty. In other words, genetic testing is most useful for confirming the diagnosis and helping families understand the overall pattern of symptoms, rather than forecasting the full course in detail.
Causes and risk factors
The genetic causes of lethal kniest-like dysplasia involve an inherited or new change in a gene needed for cartilage and bone growth before birth. In many families, this change happens for the first time in the baby, but it can sometimes be passed down from a parent. The main biological risk factor is a family history of lethal kniest-like dysplasia or a related skeletal dysplasia. Genetic testing can sometimes clarify your personal risk. Lifestyle, diet, and most environmental exposures are not known to be the main cause of lethal kniest-like dysplasia.
What are the most common causes or risk factors?
Lethal kniest-like dysplasia is almost always caused by a harmful change in a gene that helps build cartilage and bone, most often COL2A1, which makes an important kind of collagen needed for the skeleton to grow normally. These gene changes usually happen for the first time in the baby rather than being passed down, although inherited cases can happen. There are no well-established lifestyle, pregnancy, or environmental risk factors known to cause this condition.
Environmental and biological risk factors
When families ask about the risk factors for Lethal kniest-like dysplasia, there is usually no clear link to everyday exposures or anything done during pregnancy. Most of the known risk appears to come from a biological change that happens very early in development, often by chance. Clear environmental triggers have not been firmly proven.
Most cases are thought to start with a new change in a gene that helps cartilage and bone form. This usually happens by chance around conception, not because of ordinary pregnancy activities.
The key biological events happen in the first weeks of pregnancy, when the skeleton is beginning to form. Because this timing is so early, later day-to-day exposures have not been shown to be a main cause.
No specific medicine, infection, food, or household exposure has been firmly proven to cause Lethal kniest-like dysplasia. That can be important to know for families who worry they somehow caused it.
Genetic risk factors
When families ask about the genetic causes of lethal kniest-like dysplasia, the main finding is usually a harmful change in COL2A1, a gene that is important for cartilage and early bone growth. Most reported cases seem to happen for the first time in the child, rather than being passed down through generations. In some cases, genetic testing can give a clearer picture of your personal risk.
COL2A1 changes: The main known genetic cause is a disease-causing change in COL2A1, which helps the body make type II collagen for developing cartilage. When this gene is altered, the skeleton can form abnormally very early in pregnancy.
New variant: Many cases result from a new genetic change that is not found in either parent’s blood cells. When this happens, the chance of the condition happening again is often low, although it is not zero.
Parental mosaicism: Rarely, a parent carries the genetic change in only some egg or sperm cells, a situation called mosaicism. This can lead to more than one affected pregnancy even when both parents are healthy and routine blood testing is normal.
Family history: A known COL2A1 variant in a parent or close relative can increase the genetic risk in a future pregnancy. This is uncommon in lethal kniest-like dysplasia, but it becomes more important when there is a family history of a related collagen disorder.
Lifestyle risk factors
Lifestyle habits do not cause lethal Kniest-like dysplasia. Because this condition develops before birth, there are no established lifestyle risk factors for lethal Kniest-like dysplasia in the usual sense, such as diet or exercise causing the disorder itself. In practice, how lifestyle affects lethal Kniest-like dysplasia is mainly through pregnancy health, prenatal monitoring, and support around complications and care planning.
Regular prenatal visits and recommended imaging can improve early recognition of severe skeletal shortening, a small chest, and other features linked to lethal Kniest-like dysplasia. Earlier detection can help families and clinicians prepare for delivery, neonatal needs, and possible pregnancy complications.
Avoiding smoking, vaping, alcohol, and non-prescribed drugs does not prevent lethal Kniest-like dysplasia, but it supports placental function and overall fetal well-being during an already high-risk pregnancy. Reducing these exposures may also lower added risks such as poor growth, preterm birth, or maternal complications that can complicate management.
Good maternal nutrition and management of conditions such as diabetes or severe anemia do not change the underlying skeletal disorder. They can still support maternal health and may make it easier to monitor the pregnancy and respond to complications related to a severely affected fetus.
Normal pregnancy activity, when approved by an obstetric clinician, does not worsen the dysplasia itself. Activity choices may need adjustment if there is polyhydramnios, discomfort, or preterm labor risk, because those issues can increase the physical strain of the pregnancy.
Risk prevention
Lethal kniest-like dysplasia is a very rare genetic skeletal condition, and true prevention of the condition itself is usually not possible once the genetic change is present. In practice, prevention focuses on reproductive counseling before or during pregnancy and, when a pregnancy is affected, on lowering avoidable complications as much as possible through careful specialist care. Some prevention is universal, others are tailored to people with specific risks. Because this condition is typically severe before birth, families often need support with both genetic information and pregnancy planning.
If there is a family history of lethal kniest-like dysplasia or a known gene change, genetic counseling can help clarify recurrence risk before pregnancy. This may help families understand testing choices, including carrier testing, embryo testing, or prenatal testing when appropriate.
Preconception care can lower general pregnancy risks by reviewing medicines, managing health conditions, and updating vitamins such as folic acid. While this does not prevent lethal kniest-like dysplasia itself, it supports the healthiest possible pregnancy.
When there is a known risk, prenatal testing may help detect an affected pregnancy early. For many families, this can mean earlier, clearer decisions and better planning for specialist care.
Detailed ultrasound during pregnancy can pick up severe bone growth problems and other features linked to lethal kniest-like dysplasia. Early imaging does not change the gene change, but it can reduce delays in diagnosis and guide safer pregnancy monitoring.
Can you prevent Lethal kniest-like dysplasia?
No, this condition usually cannot be prevented. It is caused by a genetic change that affects how bones and cartilage develop before birth, and there are no known lifestyle steps that can stop it. If it has happened in a family before, genetic counseling may help people understand the chance of it happening again and talk through testing options for a future pregnancy.
Transmission
Lethal kniest-like dysplasia is not infectious, so it cannot be caught from someone else or passed through the air, food, touch, or sex. Instead, it is a genetic condition that begins before birth because of a change in a gene that affects bone and cartilage development.
When people ask about the genetic transmission of Lethal kniest-like dysplasia, the key point is that it may be passed from parent to child in some families, but in many rare severe skeletal conditions the gene change happens for the first time in the baby. If a family has been affected, a genetics specialist can explain recurrence risk and how Lethal kniest-like dysplasia is inherited in that specific situation.
When to test your genes
Genetic testing is most useful before or during pregnancy if ultrasound shows severe skeletal dysplasia, short limbs, a very small chest, or other findings suggesting lethal kniest-like dysplasia. It is also important after an affected pregnancy or baby to confirm the diagnosis, clarify recurrence risk, and guide future family planning.
Diagnosis
Lethal Kniest-like dysplasia is usually diagnosed when very severe bone and body growth differences are seen before birth or at delivery, then confirmed with targeted testing. In many families, the first clues come from ultrasound findings such as very short limbs, a small chest, and other skeletal changes that suggest a serious skeletal condition. The diagnosis of lethal Kniest-like dysplasia often combines imaging findings, the baby’s physical features, and genetic tests to confirm the cause.
Doctors often first suspect this condition during pregnancy when ultrasound shows marked shortening of the arms and legs, a narrow chest, and poor bone growth. These findings can suggest a severe skeletal dysplasia and help guide referral to specialists in maternal-fetal medicine and genetics.
After birth, doctors examine the baby for characteristic clinical features, including very short limbs, a small chest, and distinctive facial or skeletal differences. These findings help narrow the diagnosis, although several rare bone disorders can look similar at first.
A full set of skeletal X-rays can show the pattern of bone changes throughout the body, including abnormalities in the spine, long bones, and pelvis. This imaging helps doctors distinguish lethal Kniest-like dysplasia from other severe skeletal dysplasias with overlapping features.
Genetic tests are used to look for the underlying gene change that caused the condition and can confirm the genetic diagnosis of lethal Kniest-like dysplasia. If you’re worried about yourself or a loved one, you’re not alone. Testing may be done during pregnancy or after delivery, depending on when the condition is first suspected.
How is Lethal kniest-like dysplasia diagnosed?
Doctors usually suspect lethal kniest-like dysplasia during pregnancy or right after birth when ultrasound or X-rays show a clear pattern of severe bone growth problems, such as very short arms and legs, a small chest, and unusual bone and joint shape. They also look at the baby's overall physical features and how the skeleton is developing. A genetic test, often checking a gene called COL2A1, can help confirm the diagnosis, but doctors mainly make the diagnosis from the pattern seen on imaging and exam.
Stages of Lethal kniest-like dysplasia
Lethal kniest-like dysplasia does not have defined progression stages. This is because it is a severe condition that is usually recognized before birth or around delivery, rather than something that slowly moves through clear step-by-step phases over time. Doctors usually start with a conversation about pregnancy findings and then use ultrasound imaging, physical features, and skeletal X-rays after birth to understand what is causing the bone and chest changes. In some families, genetic testing may be offered to confirm the diagnosis and clarify how Lethal kniest-like dysplasia is diagnosed.
Outlook and prognosis
The outlook for infants with lethal Kniest-like dysplasia is extremely poor, with death typically occurring before birth or in the neonatal period because of severe skeletal abnormalities and a very small chest that cannot support adequate breathing. In reported cases, respiratory failure from pulmonary hypoplasia is the usual cause of death. Because the condition is considered lethal, long-term survival is not expected. Management during pregnancy and after delivery is therefore focused on confirming the diagnosis, assessing the severity of lung and skeletal involvement, and supporting family decision-making. Families may benefit from early involvement of maternal-fetal medicine, neonatology, genetics, and palliative care teams to discuss expected outcomes and care options.
Long-term effects
For families facing lethal kniest-like dysplasia, the biggest day-to-day issue is usually survival around birth rather than long-term health over many years. This condition is generally considered a very severe skeletal disorder, and most affected babies die before birth or shortly after delivery. The outlook is mainly shaped by how underdeveloped the chest and lungs are, along with the severity of the bone changes. Everyone’s path looks different, but long-term survival with lethal kniest-like dysplasia appears to be extremely uncommon.
The most serious long-term effect of lethal kniest-like dysplasia is that many affected babies do not survive the pregnancy or the newborn period. This is why discussions often focus less on the early symptoms of lethal kniest-like dysplasia and more on survival at and around birth.
A very small chest can limit how well the lungs develop before birth. After delivery, this often leads to severe breathing failure that can be life-limiting within hours or days.
The bones are typically very short and abnormally formed, and the spine, ribs, and limbs can all be affected. These changes are not just differences in appearance, because they can also interfere with basic body functions needed for survival.
Because long-term survival is so rare, there is very little information about health effects later in childhood or adulthood. Doctors may track these changes over years to see patterns in other skeletal conditions, but for lethal kniest-like dysplasia the available long-term experience is extremely limited.
How is it to live with Lethal kniest-like dysplasia?
Lethal kniest-like dysplasia is an extremely severe genetic skeletal condition, and in most reported cases it causes such serious problems with bone growth and breathing that affected babies die before birth or shortly after delivery. Because of that, there is usually no long-term day-to-day life with the condition; for families, the lived experience is more often one of intensive monitoring during pregnancy, possible time in a neonatal intensive care unit, and the heavy emotional impact of grief, uncertainty, and difficult medical decisions that can affect parents, siblings, and other loved ones.
Treatment and drugs
Lethal Kniest-like dysplasia is a very severe skeletal condition, and treatment focuses on supportive care rather than a cure because the bone and chest changes can make breathing impossible or very limited from birth. During pregnancy, care usually centers on close monitoring, careful delivery planning, and honest discussions with a specialist team about what to expect for the baby and family. After birth, treatment may include comfort-focused care, oxygen, or other breathing support, but in many cases the condition is sadly not survivable because the lungs and rib cage cannot support normal breathing. Support from family or friends can make daily treatment easier, and parents are often offered help from neonatology, genetics, palliative care, and bereavement teams to guide decisions and provide emotional support.
Can you cure Lethal kniest-like dysplasia?
No. There is currently no cure for lethal Kniest-like dysplasia, a very severe condition that disrupts bone growth before birth and is usually not survivable. Treatment cannot reverse the condition, so care is focused on confirming the diagnosis, supporting the family during pregnancy and delivery, and providing comfort care for the baby if needed.
Non-drug treatment
Living with lethal kniest-like dysplasia usually means care is centered on comfort, breathing support, and helping families make informed decisions during pregnancy and after birth. Because this condition causes very severe bone and chest changes, treatment is supportive rather than curative, and needs can change quickly around delivery. For many, treatment begins not at the pharmacy, but with careful planning by a team that may include maternal-fetal medicine, newborn specialists, palliative care, and genetics.
Care often starts before delivery with detailed pregnancy monitoring and a plan for where and how the baby will be born. This helps the team prepare for breathing problems, comfort care, and family wishes right away.
The small chest and severe bone changes can make breathing very hard from birth. Non-drug treatments may include oxygen, gentle ventilation, or other breathing support, depending on the baby’s needs and the goals of care.
Some babies cannot feed safely by mouth because breathing is so fragile. Supportive therapies can include careful hand feeding, tube feeding, or comfort feeding, with a focus on reducing distress.
Palliative care focuses on warmth, gentle handling, skin-to-skin contact, and easing discomfort for the baby while supporting parents and loved ones. In many families, this becomes the main approach because lethal kniest-like dysplasia is expected to severely shorten life.
Your genes may have an impact on how drugs work for you
For families affected by lethal Kniest-like dysplasia, medicines are usually used for comfort and supportive care rather than to treat the underlying condition, so there are no well-known, condition-specific drug-response patterns linked to a person’s genes. In other words, the genetic change that causes this disorder is mainly important for diagnosis and understanding the condition, not for predicting how most common medicines will work. Doctors still choose and adjust medicines carefully based on the baby’s breathing, pain, feeding needs, and overall health, because responses can vary from one child to another even without a known gene-related effect on the drug.
Pharmacological treatments
Lethal kniest-like dysplasia is a very severe skeletal condition that causes major problems with bone growth, breathing, and life support from birth. There is no medicine that can cure or reverse it, so drug treatment is supportive and focused on comfort and urgent complications. In practice, medicines may be used around breathing care, pain relief, infection treatment, and intensive care needs in the newborn period.
Acetaminophen and sometimes opioid medicines such as morphine may be used to ease discomfort during intensive care or procedures. The exact choice depends on how sick the baby is and whether breathing is already fragile.
Drugs such as fentanyl, midazolam, or morphine may be given if a baby needs mechanical ventilation or other invasive support. These medicines help with comfort and reduce distress, but they require very close monitoring.
If there is concern for pneumonia, sepsis, or another serious infection, doctors may use antibiotics such as ampicillin and gentamicin or other hospital-based options. Treatment is guided by the baby's age, test results, and how unstable they are.
Some newborns receive surfactant if severe lung disease is also present, and inhaled nitric oxide may be considered in selected cases with major oxygen problems. These medicines do not treat lethal kniest-like dysplasia itself, but they may support breathing for a short time.
Genetic influences
With lethal Kniest-like dysplasia, the changes in bone growth usually begin very early in pregnancy, when a gene problem disrupts how cartilage and bone are formed. This means the condition is genetic in origin and is not caused by anything parents did or did not do during pregnancy. Because the name lethal Kniest-like dysplasia describes a pattern of skeletal changes rather than one single known gene result, doctors often rely on genetic testing to look for the specific change in that family and to estimate the chance of it happening again in a future pregnancy. Understanding whether this condition is inherited can guide next steps. A genetics specialist can help explain whether the change happened for the first time or may also affect other relatives.
Is Lethal kniest-like dysplasia genetic?
Genetics are central to lethal Kniest-like dysplasia, which is caused by harmful changes in genes involved in building cartilage and bone. These genetic variations disrupt early skeletal development and are the main reason the condition occurs.
Having a genetic risk is not necessarily a diagnosis
Genetic variants are a usual part of being human and are widely seen across the general population. Most do not directly affect health and simply add to natural human diversity. For many genes, carrying a variant associated with a condition suggests a possible link rather than a confirmed diagnosis, especially when several genes and environmental factors also play a part. In some situations, though, a single well-characterized variant in a particular gene can be enough to confirm the diagnosis.
Pharmacogenetics—how genetics influence drug effects
For families facing lethal kniest-like dysplasia, the genetic finding matters most because it confirms the diagnosis and helps the care team plan what treatment is realistic. At present, there is no approved medicine that can correct the underlying gene change or reverse the severe problems in cartilage, bone growth, and chest development that make lethal kniest-like dysplasia so serious. In practice, treatment options for lethal kniest-like dysplasia are usually supportive, such as planning for delivery, breathing support if a baby is born alive, and comfort medicines to ease distress rather than trying to change the disease itself. Finding the exact genetic cause can also help doctors tell this condition apart from other skeletal disorders that may look similar but can have different care needs and outlook. This information is often most useful for guiding family counseling, future pregnancy planning, and decisions about care, rather than choosing a specific long-term drug.
Interactions with other conditions
For families facing lethal kniest-like dysplasia, the main medical concern is how the severe bone and chest changes can affect other parts of the body, especially breathing. Because the rib cage is often very small, babies with lethal kniest-like dysplasia may not be able to expand their lungs well, and even a mild infection can become much more serious. Doctors call it a “comorbidity” when two conditions occur together, but in this condition the breathing problem is usually part of the overall disorder rather than a separate illness. There can also be overlap with other rare skeletal disorders, so the early symptoms of lethal kniest-like dysplasia may at first look similar to other conditions that cause very short limbs, a narrow chest, and severe breathing failure. In practice, care is focused on confirming the diagnosis and understanding how the bone disorder is affecting the lungs and other organs, rather than on long-term interactions with unrelated diseases.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Lethal kniest-like dysplasia?
Yes. Other rare bone growth conditions can look very similar, especially Kniest dysplasia, thanatophoric dysplasia, and achondrogenesis, because they can also cause very short arms and legs, a small chest, unusual joint or spine changes, and severe breathing problems before or soon after birth. Doctors may also compare it with some other severe skeletal dysplasias, which is the medical term for disorders that change how bones and cartilage grow.
History
Families facing lethal Kniest-like dysplasia are often looking for answers very early, sometimes during pregnancy, when scans show that the bones are not growing in the usual way and the chest may be very small. The condition came to medical attention through these striking bone changes and through similarities to other severe skeletal disorders, which made early diagnosis difficult.
Initially understood only through symptoms, later reports helped doctors separate lethal Kniest-like dysplasia from conditions that can look similar on imaging or at birth. In the past, some babies with this pattern of findings may have been placed under broader labels for short-limbed skeletal dysplasia because the differences between disorders were not yet clear. As imaging, pathology, and specialist review improved, doctors became better able to recognize the combination of very short limbs, distinctive bone changes, and a life-limiting small chest that points to lethal Kniest-like dysplasia.
Over time, the way the condition has been understood has changed, and that has mattered for families. What was once described mainly from physical findings after birth came to be recognized more accurately before birth through ultrasound and, later, more detailed imaging and laboratory testing. Researchers also learned that disorders in this group can have overlapping features, so careful diagnosis is important for counseling, pregnancy planning, and understanding what to expect.
Today, lethal Kniest-like dysplasia is recognized as a very rare, severe skeletal condition within a larger family of bone growth disorders. That clearer historical picture helps explain why older medical reports may use different names or place similar cases in different categories. Knowing this history can also make the early symptoms of lethal Kniest-like dysplasia easier to understand in context, especially when families are hearing several possible diagnoses during a stressful time.