Differential Diagnosis for Nonblanchable Petechiae, Thrombocytopenia, and Elevated Liver Enzymes
- Single Most Likely Diagnosis
- Viral Hepatitis: This condition can lead to thrombocytopenia due to splenic sequestration from portal hypertension, and liver enzyme elevation is a hallmark of hepatitis. Nonblanchable petechiae can occur due to thrombocytopenia.
- Other Likely Diagnoses
- Immune Thrombocytopenic Purpura (ITP): Although primarily known for causing thrombocytopenia and petechiae, some cases can have mild liver enzyme elevations, especially if there's an associated autoimmune hepatitis.
- Chronic Liver Disease: Conditions like cirrhosis can lead to thrombocytopenia (due to splenic sequestration) and elevated liver enzymes. Petechiae can be seen due to thrombocytopenia.
- Disseminated Intravascular Coagulation (DIC): This condition can cause thrombocytopenia and elevated liver enzymes due to microthrombi formation in the liver. Petechiae can be part of the purpura fulminans seen in DIC.
- Do Not Miss Diagnoses
- Thrombotic Thrombocytopenic Purpura (TTP): A rare but life-threatening condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, neurological symptoms, and fever. Liver enzyme elevation can occur, and petechiae are common.
- Hemophagocytic Lymphohistiocytosis (HLH): This is a rare disorder of the immune system where the body makes too many activated immune cells called macrophages and lymphocytes. It can cause thrombocytopenia, elevated liver enzymes, and petechiae due to bone marrow failure and liver involvement.
- Rare Diagnoses
- Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver enzyme elevation and thrombocytopenia due to splenomegaly from portal hypertension. Petechiae can occur due to thrombocytopenia.
- Budd-Chiari Syndrome: A rare condition caused by occlusion of the hepatic veins, leading to liver enlargement, ascites, and abdominal pain. It can cause thrombocytopenia and elevated liver enzymes, with petechiae possible due to thrombocytopenia.