Differential Diagnosis for 25-year-old Female with Fever, Headache, and Generalized Rash
Single Most Likely Diagnosis
- Rocky Mountain Spotted Fever (RMSF): This diagnosis is highly considered due to the presence of fever, headache, and a generalized rash that includes the palms and soles. RMSF is prevalent in Texas and is known for its characteristic rash, which often appears on the wrists, ankles, palms, and soles.
Other Likely Diagnoses
- Syphilis (Secondary): Secondary syphilis can present with a generalized rash, including on the palms and soles, along with fever and headache. This diagnosis should be considered, especially if the patient has a history of unprotected sexual activity.
- Viral Exanthems (e.g., Enterovirus, Adenovirus): Various viral infections can cause fever, headache, and rash. While the rash may not typically involve the palms and soles, some viral exanthems can present with such characteristics.
- Ehrlichiosis/Anaplasmosis: These tick-borne illnesses can cause fever, headache, and rash, although the rash is less commonly found on the palms and soles compared to RMSF.
Do Not Miss Diagnoses
- Meningococcemia: This condition, caused by Neisseria meningitidis, can present with fever, headache, and a rash that may include the palms and soles. It is critical to consider this diagnosis due to its high mortality rate if left untreated.
- Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Although rare, these severe skin and mucous membrane disorders can be triggered by infections or medications and require immediate medical attention.
- Endocarditis: Infective endocarditis can cause fever, headache, and rash (including Janeway lesions on the palms and soles), especially in individuals with pre-existing heart conditions.
Rare Diagnoses
- Leptospirosis: This bacterial infection can cause fever, headache, and rash, but it is less common and typically associated with exposure to contaminated water.
- Rickettsialpox: Caused by Rickettsia akari, this illness can present with fever, headache, and a rash that may include the palms and soles, but it is rare and usually linked to exposure to mites.
- Lyme Disease (Late Stage): While Lyme disease is more commonly associated with a distinctive "bull's-eye" rash, late-stage disease can cause a variety of symptoms, including fever and headache, but a generalized rash involving the palms and soles would be unusual.