Differential Diagnosis for SCD with Persistent Fever, High Inflammatory Markers, Abdominal Pain, Positive Murphy Sign, and Right Iliac Fossa Pain with Rebound Tenderness
- Single Most Likely Diagnosis
- Acute Appendicitis: The combination of abdominal pain, particularly in the right iliac fossa, rebound tenderness, and a positive Murphy sign (although more specific to gallbladder disease, it can be seen in conditions causing peritoneal irritation), along with high inflammatory markers and fever, strongly suggests acute appendicitis. The presence of these symptoms and signs together is highly indicative of this condition.
- Other Likely Diagnoses
- Cholecystitis: Given the positive Murphy sign, cholecystitis (inflammation of the gallbladder) is a plausible diagnosis. It can present with fever, abdominal pain (especially right upper quadrant pain), and elevated inflammatory markers. The pain can sometimes radiate or be referred to the right iliac fossa.
- Diverticulitis: Although more common on the left side, diverticulitis (inflammation of a diverticulum in the digestive tract) can occur on the right side and present with fever, abdominal pain, and high inflammatory markers. The presence of rebound tenderness supports a diagnosis involving peritoneal irritation.
- Intestinal Obstruction: This condition can cause severe abdominal pain, fever if there's associated ischemia or necrosis, and elevated inflammatory markers. The pain can be diffuse or localized, depending on the obstruction site.
- Do Not Miss Diagnoses
- Perforated Visculitis or Vasculitis: Conditions like Henoch-Schönlein purpura or other forms of vasculitis can cause abdominal pain, fever, and elevated inflammatory markers. A perforation would lead to peritonitis, explaining the rebound tenderness.
- Ectopic Pregnancy: Although less likely in the context of SCD (sickle cell disease), an ectopic pregnancy can present with abdominal pain and fever. It's crucial to consider this in any female patient of childbearing age, as missing this diagnosis can be fatal.
- Intra-abdominal Abscess: An abscess within the abdominal cavity can cause fever, abdominal pain, and elevated inflammatory markers. It might not always present with clear signs of peritonitis but can be a complication of various conditions, including those listed above.
- Rare Diagnoses
- Sickle Cell Crisis with Intra-abdominal Involvement: While SCD can cause abdominal pain due to vaso-occlusive crises, the presence of high inflammatory markers and specific signs like a positive Murphy sign and rebound tenderness are less common. However, it's essential to consider the patient's underlying condition as a potential contributor to their symptoms.
- Right Lower Lobe Pneumonia: Sometimes, a pneumonia can cause referred abdominal pain, especially if the diaphragm is involved. However, the combination of symptoms provided makes this a less likely diagnosis.
- Ovarian Torsion: This is another condition that can cause severe abdominal pain and might be associated with fever and elevated inflammatory markers if there's associated necrosis. It's more common in women and can be a surgical emergency.