Differential Diagnosis for 27-year-old Female with Skin Sores, Cough, Pneumonia, Fever, and Hematuria
Single most likely diagnosis:
- Leptospirosis: This diagnosis is highly likely due to the patient's symptoms, including skin sores, cough, signs of pneumonia, fever, and later development of hematuria (blood in urine). Leptospirosis is a common zoonotic infection in the Philippines, transmitted through water or soil contaminated with the urine of infected animals. The disease can range from a mild flu-like illness to a more severe form known as Weil's disease, which includes symptoms like kidney or liver failure, and can be life-threatening if not treated promptly.
Other Likely diagnoses:
- Melioidosis: Caused by the bacterium Burkholderia pseudomallei, melioidosis can present with a wide range of symptoms including skin sores, pneumonia, and fever. It is endemic in Southeast Asia and northern Australia, and exposure to contaminated water or soil is a common mode of infection.
- Tuberculosis (TB): Although TB is more commonly associated with chronic symptoms, it can present acutely, especially in immunocompromised individuals. The presence of cough, fever, and signs of pneumonia could suggest pulmonary TB, while hematuria might indicate genitourinary involvement.
- Dengue Hemorrhagic Fever: This condition, prevalent in the Philippines, can cause severe flu-like symptoms, hemorrhaging (which could explain the hematuria), and in severe cases, plasma leakage or low platelet count. Skin sores might not be a primary symptom but could be secondary to thrombocytopenia.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Rickettsial Infections (e.g., Scrub Typhus): These infections, caused by bacteria transmitted by ticks or mites, can present with fever, headache, and a characteristic eschar at the bite site. They are endemic in parts of Asia, including the Philippines, and can be severe if not treated with appropriate antibiotics.
- Hantavirus Infection: Although less common, hantavirus can cause severe diseases like Hantavirus Pulmonary Syndrome (HPS) or Hemorrhagic Fever with Renal Syndrome (HFRS), which could explain the patient's symptoms, including hematuria and respiratory distress.
- Sepsis due to any bacterial infection: Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Any bacterial infection, including those mentioned above, could potentially lead to sepsis if not promptly and adequately treated.
Rare diagnoses:
- Relapsing Fever: Caused by certain species of Borrelia transmitted by ticks or lice, relapsing fever can present with recurring episodes of fever, which might fit the patient's initial fever and later development of hematuria, though it's less likely given the geographical and clinical context.
- Ehrlichiosis/Anaplasmosis: These are tick-borne bacterial infections that can cause fever, headache, and sometimes more severe symptoms like respiratory failure or renal failure, which could align with some of the patient's symptoms, though they are less common in the Philippines.