Differential Diagnosis for Maculopapulotic Rash with Ischaemic Infarct and Temperature
Single Most Likely Diagnosis
- Infective Endocarditis: This condition is a strong consideration given the combination of a maculopapulotic rash, which could be indicative of Janeway lesions or other embolic phenomena, alongside an ischemic infarct, which might result from septic emboli. The presence of a temperature suggests an infectious process.
Other Likely Diagnoses
- Vasculitis (e.g., Systemic Lupus Erythematosus, Rheumatoid Arthritis): These conditions can cause a maculopapulotic rash, ischemic infarcts due to vasculitis of blood vessels, and fever. They are systemic diseases that can affect multiple organ systems, including the nervous system.
- Meningitis or Encephalitis: Although these conditions primarily affect the central nervous system, they can cause fever and, in some cases, a rash. The ischemic infarct could be a complication of the infection or inflammation affecting the blood vessels.
- Neurosyphilis: This condition can present with a wide range of neurological symptoms, including those that mimic a stroke. A maculopapulotic rash can be seen in secondary syphilis, and fever can occur in various stages of the disease.
Do Not Miss Diagnoses
- Meningococcemia: This is a life-threatening condition that can cause a rash (often petechial or purpuric but can start as maculopapular), fever, and can lead to complications such as ischemic infarcts due to vasculitis or disseminated intravascular coagulation. It requires immediate recognition and treatment.
- Rocky Mountain Spotted Fever (RMSF): Although less common, RMSF can present with a maculopapulotic rash that becomes petechial, fever, and neurological symptoms, including those that could mimic an ischemic infarct. It is crucial to consider this diagnosis, especially in endemic areas, due to its high mortality if untreated.
Rare Diagnoses
- Ehlers-Danlos Syndrome with associated vascular complications: This genetic disorder can lead to fragile blood vessels, increasing the risk of ischemic events. Some types of Ehlers-Danlos Syndrome are associated with easy bruising and poor wound healing, which might be mistaken for a rash.
- Fabry Disease: A genetic disorder that can cause a range of systemic symptoms, including skin lesions (angiokeratomas), neurological manifestations, and increased risk of stroke. Fever might not be a primary symptom but could occur in the context of other systemic complications.
- Sneddon Syndrome: A rare condition characterized by livedo reticularis (a mottled, purplish discoloration of the skin) and stroke. While it doesn't typically present with a maculopapulotic rash, the livedo could be confused with such a rash, and the condition's association with stroke makes it worth mentioning in a differential diagnosis involving ischemic infarcts.