Differential Diagnosis for Spontaneous Bruise on the Forefoot
- Single most likely diagnosis
- Achenbach’s syndrome: This is a condition characterized by spontaneous bruising, typically on the feet or hands, due to a rupture of small blood vessels. Given the presentation of a spontaneous bruise on the forefoot of a middle-aged woman, Achenbach’s syndrome is a plausible diagnosis.
- Other Likely diagnoses
- Trauma: Even if the patient does not recall a specific incident, minor trauma could have caused the bruise. This is a common and straightforward explanation for a bruise.
- Vasculitis: Conditions like leukocytoclastic vasculitis could lead to bruising due to inflammation of small blood vessels.
- Thrombocytopenia or platelet dysfunction: Disorders affecting platelet count or function could increase the risk of bruising.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Deep vein thrombosis (DVT): Although less common in the foot, DVT could potentially cause bruising and is a serious condition requiring prompt treatment.
- Malignancy: Rarely, a bruise could be a sign of an underlying malignancy, such as a tumor causing vascular obstruction or invasion.
- Infection (e.g., cellulitis or abscess): Infections can cause bruising and are important to diagnose and treat to prevent serious complications.
- Rare diagnoses
- Scurvy: Vitamin C deficiency can lead to poor collagen synthesis, resulting in fragile blood vessels and bruising.
- Ehlers-Danlos syndrome: A genetic disorder affecting connective tissue, which could lead to easy bruising due to fragile blood vessels.
- Amyloidosis: A condition characterized by the deposition of abnormal proteins, which can affect blood vessels and lead to bruising.