Differential Diagnosis
The patient's symptoms of a rash on bilateral hands, joint pain, and gastrointestinal symptoms (GI SX) after traveling to Hawaii can be approached by considering the following categories:
- Single most likely diagnosis
- Dengue Fever: This is a likely diagnosis given the patient's recent travel to Hawaii, where dengue fever has been reported. The symptoms of joint pain, rash, and GI symptoms are consistent with dengue fever.
- Other Likely diagnoses
- Chikungunya: Similar to dengue fever, chikungunya is a mosquito-borne illness that can cause joint pain, rash, and GI symptoms. Hawaii has reported cases of chikungunya, making it a plausible diagnosis.
- Zika Virus: Another mosquito-borne illness, Zika virus can cause rash, joint pain, and GI symptoms. Although less common than dengue fever and chikungunya, it is still a possible diagnosis given the patient's travel history.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Leptospirosis: This bacterial infection can cause a range of symptoms, including joint pain, rash, and GI symptoms. Although less common, leptospirosis can be severe and even life-threatening if left untreated.
- Rat Lungworm Disease (Angiostrongylus cantonensis): This parasitic infection can cause severe symptoms, including joint pain and GI symptoms. While rare, it is a potentially deadly diagnosis that should not be missed, especially given the patient's travel to Hawaii where the parasite is found.
- Rare diagnoses
- Hawaiian Tick-Borne Rickettsial Disease: This rare disease can cause symptoms such as rash, joint pain, and GI symptoms. Although unlikely, it is a possible diagnosis given the patient's travel to Hawaii.
- Ehrlichiosis: This bacterial infection can cause symptoms such as rash, joint pain, and GI symptoms. While rare, it is a possible diagnosis that should be considered in the differential diagnosis.