Differential Diagnosis for 27-year-old Female with Skin Sores, Cough, Fever, and Hematuria
- Single most likely diagnosis:
- Leptospirosis: This diagnosis is likely due to the combination of symptoms such as fever, cough, and hematuria (blood in urine), which are common in leptospirosis. The presence of skin sores could be related to the initial entry point of the bacteria. Leptospirosis is prevalent in the Philippines, especially after flooding or exposure to contaminated water.
- Other Likely diagnoses:
- Dengue Fever: Given the symptoms of fever, cough, and the geographical location (Philippines), dengue fever is a plausible diagnosis. However, hematuria is less commonly associated with dengue.
- Tuberculosis (TB): TB can cause a wide range of symptoms including cough, fever, and in rare cases, skin sores and hematuria if it affects the kidneys. The Philippines has a high incidence of TB.
- Pyelonephritis or other urinary tract infections: These could explain the hematuria and fever, but the skin sores and cough might not be directly related unless there's a complication like sepsis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Sepsis: Regardless of the primary cause, the combination of fever, cough, skin sores, and hematuria could indicate a severe infection leading to sepsis, which is life-threatening and requires immediate attention.
- Meningitis: Although less likely given the symptoms, meningitis can present with fever, cough (if there's an associated respiratory infection), and in severe cases, petechial rash (which could be mistaken for skin sores). Hematuria would be uncommon but could occur in severe sepsis.
- Hemorrhagic Fever with Renal Syndrome (HFRS): Caused by hantaviruses, this disease can present with fever, renal failure (leading to hematuria), and in some cases, skin manifestations. It's less common but can be deadly.
- Rare diagnoses:
- Melioidosis: A bacterial infection caused by Burkholderia pseudomallei, which can cause a wide range of symptoms including skin sores, fever, cough, and urinary symptoms. It's rare but can be severe and is found in Southeast Asia.
- Rat-bite fever: Caused by Streptobacillus moniliformis or Spirillum minus, this infection can result from the bite of an infected rodent. Symptoms can include fever, skin sores at the bite site, and in severe cases, systemic symptoms. Hematuria could occur in severe infections.