Differential Diagnosis for Maculopapular Rash with Sudden Onset at Febrile Patient with Acute Ischaemic Infarct and Anuria
- Single Most Likely Diagnosis
- Vasculitis (e.g., Henoch-Schönlein Purpura or ANCA-associated vasculitis): The combination of a maculopapular rash, fever, acute ischemic infarct, and anuria suggests a systemic vasculitis. These conditions can cause inflammation of blood vessels, leading to ischemic events and renal failure, which aligns with the patient's symptoms.
- Other Likely Diagnoses
- Infective Endocarditis: This condition can cause fever, rash (including maculopapular types), and embolic events leading to ischemic infarcts. Renal involvement can occur due to emboli or immune complex deposition.
- Meningococcemia: Although more commonly associated with a petechial or purpuric rash, meningococcemia can present with a maculopapular rash in early stages. It causes fever, can lead to ischemic events due to vasculitis, and may result in renal failure.
- Disseminated Intravascular Coagulation (DIC): DIC can cause a variety of skin manifestations, including maculopapular rashes, and is associated with thrombotic events (like ischemic infarcts) and renal failure due to microangiopathic changes.
- Do Not Miss Diagnoses
- Thrombotic Thrombocytopenic Purpura (TTP): Although TTP typically presents with a pentad of thrombocytopenia, microangiopathic hemolytic anemia, renal failure, neurological symptoms, and fever, some cases may have atypical presentations. The ischemic infarct and anuria could be part of TTP's clinical spectrum.
- Hemolytic Uremic Syndrome (HUS): Similar to TTP, HUS can cause renal failure and ischemic events. While it's more commonly associated with diarrhea-causing bacteria like E. coli O157:H7, atypical HUS can have a broader range of triggers.
- Rare Diagnoses
- Ehlers-Danlos Syndrome with Vascular Complications: This genetic disorder can lead to fragile blood vessels, increasing the risk of ischemic events and potentially causing a rash due to skin fragility. However, it's a less common condition and would be considered only after more likely diagnoses are ruled out.
- Scurvy: Caused by vitamin C deficiency, scurvy can lead to a variety of symptoms including a rash, poor wound healing, and potentially ischemic events due to vascular fragility. It's rare in developed countries but could be seen in cases of severe malnutrition.