Differential Diagnosis for 11-year-old Female with Flank Pain and Tiny Bruising all over Abdomen
- Single most likely diagnosis:
- Henoch-Schönlein Purpura (HSP): This condition is a form of vasculitis that affects blood vessels and is common in children. It often presents with abdominal pain, flank pain, and purpura (tiny bruises), making it a likely diagnosis given the symptoms.
- Other Likely diagnoses:
- Nephrotic Syndrome: Although more commonly associated with significant proteinuria and edema, some cases can present with abdominal or flank pain due to ascites or fluid shifts.
- Urinary Tract Infection (UTI) or Pyelonephritis: These infections can cause flank pain and, in severe cases, might lead to sepsis, which could potentially cause petechiae or purpura.
- Appendicitis: While appendicitis typically presents with more localized pain, it can sometimes cause diffuse abdominal pain and, in rare cases, might be associated with a rash or bruising if there's a significant inflammatory response.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Abdominal Aortic Aneurysm or Dissection: Extremely rare in children but could present with severe abdominal or flank pain and potentially bruising if there's associated bleeding.
- Sepsis: Any severe infection can lead to sepsis, which might cause a rash, including petechiae or purpura, along with abdominal pain.
- Meningococcemia: A severe infection caused by Neisseria meningitidis, which can present with a rash (often petechial or purpuric), fever, and abdominal pain among other symptoms.
- Rare diagnoses:
- Hemolytic Uremic Syndrome (HUS): Typically follows a diarrheal illness caused by E. coli O157:H7 and can lead to renal failure, which might cause flank pain, though bruising is not a primary symptom.
- Thrombotic Thrombocytopenic Purpura (TTP): A rare disorder of the blood-coagulation system, causing extensive microscopic thrombi to form in the smallest blood vessels throughout the body, which could lead to abdominal pain and bruising.
- Leukemia: Certain types of leukemia can cause abdominal pain due to organomegaly and might also lead to easy bruising due to thrombocytopenia or platelet dysfunction.