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Last updated: September 13, 2025View editorial policy

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Differential Diagnosis for Fever with Rash and Hepatomegaly

Single Most Likely Diagnosis

  • Viral Hepatitis: This is a common condition that can cause fever, rash, and hepatomegaly due to inflammation of the liver. The rash can be a result of the body's immune response to the virus.

Other Likely Diagnoses

  • Infectious Mononucleosis: Caused by Epstein-Barr virus, it can lead to fever, rash (especially if the patient is given ampicillin), and hepatomegaly due to liver involvement.
  • Toxoplasmosis: Although more commonly associated with lymphadenopathy, toxoplasmosis can cause hepatomegaly and, in rare cases, a rash, especially in immunocompromised patients.
  • Leptospirosis: A bacterial infection that can cause fever, rash, and hepatomegaly, particularly in individuals who have been exposed to contaminated water.

Do Not Miss Diagnoses

  • Meningococcemia: A severe bacterial infection that can cause fever, rash (petechial or purpuric), and hepatomegaly. It is life-threatening and requires immediate treatment.
  • Rocky Mountain Spotted Fever: A tick-borne illness that can cause fever, rash, and hepatomegaly. It is critical to diagnose and treat promptly to prevent severe complications.
  • Sepsis: Although not a specific disease, sepsis can result from various infections and cause fever, rash, and hepatomegaly. It is a medical emergency.

Rare Diagnoses

  • Weil's Disease: A rare but severe form of leptospirosis that can cause fever, rash, and hepatomegaly, among other symptoms.
  • Ehrlichiosis/Anaplasmosis: Tick-borne bacterial infections that can cause fever, rash, and hepatomegaly in some cases.
  • Hemophagocytic Lymphohistiocytosis (HLH): A rare disorder of the immune system that can cause fever, rash, and hepatomegaly, often associated with a severe infection or autoimmune condition.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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