Differential Diagnosis
- Single most likely diagnosis
- Southern Tick-Associated Rash Illness (STARI) or Lyme disease: The patient's recent exposure to a bush in Texas, a region known for ticks that can transmit these diseases, combined with the presentation of a maculopapular rash and elevated transaminases, makes this a strong consideration. The rash's description, including its presence on the palms and soles, is also consistent with these diagnoses.
- Other Likely diagnoses
- Contact dermatitis: Given the patient's recent work near a bush, exposure to allergens or irritants could have caused a contact dermatitis reaction, leading to the observed rash.
- Scabies: The presence of pustules and the distribution of the rash, including the genital area, could suggest scabies, especially if the patient has had close contact with someone infected.
- Allergic reaction: An allergic reaction to an insect bite, plant, or other environmental factor could explain the rash and elevated transaminases.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Rocky Mountain Spotted Fever (RMSF): Although less common, RMSF is a tick-borne illness that can present with a rash and elevated liver enzymes. It is critical to consider this diagnosis due to its high mortality rate if left untreated.
- Ehrlichiosis/Anaplasmosis: These are tick-borne diseases that can cause fever, rash, and elevated liver enzymes. They are less common but can be severe and even life-threatening if not promptly treated.
- Rare diagnoses
- Leptospirosis: This bacterial infection can cause a rash, elevated liver enzymes, and is associated with outdoor activities. However, it is less common and typically requires exposure to contaminated water.
- Southern tick-associated alpha-gal syndrome: This condition, caused by a tick bite, leads to an allergy to red meat and can present with a rash and systemic symptoms. It is rare and might not be the first consideration but should be kept in mind given the patient's exposure history.