Differential Diagnosis for Hepatitis with Sandpaper Rash

• Single most likely diagnosis
  • Hepatitis B: This is a common cause of hepatitis and can be associated with a variety of skin manifestations, including a sandpaper-like rash, due to the immune complex deposition. The rash is often seen in the prodromal phase of the disease.
• Other Likely diagnoses
  • Hepatitis C: Although less commonly associated with skin rashes compared to Hepatitis B, Hepatitis C can also present with dermatological manifestations, including a sandpaper-like rash, particularly in the context of mixed cryoglobulinemia.
  • Autoimmune Hepatitis: This condition can sometimes present with skin rashes, including a sandpaper-like appearance, as part of its autoimmune manifestations.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Wilson's Disease: A genetic disorder leading to copper accumulation in the liver and other organs. It can cause liver disease and occasionally skin manifestations, though a sandpaper rash is not typical. Missing this diagnosis could lead to severe liver damage and death.
  • Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and, in rare cases, skin manifestations. It's crucial not to miss this diagnosis due to its potential for severe liver disease and the availability of specific treatments.
• Rare diagnoses
  • Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver that can lead to cirrhosis. While it primarily affects the bile ducts, rare skin manifestations could potentially include a sandpaper-like rash.
  • Primary Sclerosing Cholangitis (PSC): Another autoimmune disease affecting the bile ducts, which can lead to liver cirrhosis. Skin manifestations are not common but could theoretically include a rash in rare cases.