Differential Diagnosis

The patient's presentation with fever, rash, transaminitis, and positive DAT suggests an autoimmune process. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Systemic Lupus Erythematosus (SLE): The patient's symptoms, including fever, rash, transaminitis, and positive DAT, are consistent with SLE. SLE is a common cause of autoimmune hemolytic anemia (AIHA) and can also explain the patient's elevated liver enzymes and thrombocytopenia.
• Other Likely Diagnoses
  • Viral Infection (e.g., B19 or EBV): Fever, rash, and elevated liver enzymes could be due to a viral infection.
  • Immune Thrombocytopenic Purpura (ITP): Thrombocytopenia and positive DAT are consistent with ITP, although the presence of other autoimmune features makes SLE more likely.
  • Gestational Thrombocytopenia: The patient's mild thrombocytopenia could be consistent with gestational thrombocytopenia, a common condition in pregnancy.
• Do Not Miss Diagnoses
  • Lymphoma: Can cause fever, night sweats, and AIHA, and is a life-threatening condition if missed.
  • Sepsis: Can cause fever, tachycardia, and organ dysfunction, and is a life-threatening condition if missed.
  • Thrombotic Thrombocytopenic Purpura (TTP): A life-threatening condition that can cause thrombocytopenia, hemolytic anemia, and renal failure.
  • Hemolytic Uremic Syndrome (HUS): A life-threatening condition that can cause thrombocytopenia, hemolytic anemia, and renal failure.
• Rare Diagnoses
  • Parvovirus Infection: Can cause AIHA and is being investigated with serologies.
  • Other Autoimmune Disorders: The patient's positive DAT and autoimmune features could be due to other autoimmune disorders, although SLE is the most likely diagnosis.