Differential Diagnosis for a 21-year-old with Bruising

The patient presents with a complaint of bruising all over her body, despite only visible bruises on her legs, following a normal pregnancy and delivery. Her laboratory tests, including CBC, INR, CMP, and notably low LFTs, guide the differential diagnosis.

• Single most likely diagnosis
  • Easy Bruising Syndrome: This condition is characterized by an increased tendency to bruise due to capillary fragility or other non-specific factors. Given the patient's normal lab results and the absence of significant visible bruising, this diagnosis is plausible, especially considering the patient's subjective complaint of widespread bruising.
• Other Likely diagnoses
  • Vitamin C Deficiency (Scurvy): Although less common, vitamin C deficiency can cause easy bruising, among other symptoms like fatigue and malaise. The patient's low LFTs might not directly correlate, but a dietary deficiency could explain her symptoms.
  • Hormonal Changes Postpartum: Postpartum hormonal fluctuations could potentially affect blood vessels, leading to increased bruising. This, combined with the physical stress of delivery, might contribute to her condition.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Hematologic Malignancies (e.g., Leukemia): Although the CBC is normal, certain types of leukemia or other hematologic malignancies might not always present with abnormal CBC results initially. It's crucial to consider these diagnoses due to their severe implications.
  • Liver Disease (e.g., Cirrhosis): Despite normal INR and CMP, advanced liver disease can sometimes present with relatively normal lab values until late in the disease process. The mention of low LFTs is intriguing and warrants further investigation, as liver disease can lead to coagulopathy and bruising.
  • Vasculitis: Certain types of vasculitis can cause bruising and might not be immediately apparent on initial lab tests. This diagnosis is critical to consider due to its potential for serious complications.
• Rare diagnoses
  • Ehlers-Danlos Syndrome: A genetic disorder affecting connective tissue, which can lead to easy bruising among other symptoms like joint hypermobility and skin hyperextensibility.
  • Pseudoxanthoma Elasticum (PXE): A rare genetic disorder that affects the body's elastic tissues, leading to mineralization and fragmentation of elastic fibers, which can cause easy bruising, among other symptoms.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially additional diagnostic testing to determine the underlying cause of her bruising.