Differential Diagnosis for Itchy Red Nodules in 3rd Trimester of Pregnancy
Single Most Likely Diagnosis
- Intrahepatic Cholestasis of Pregnancy (ICP): This condition is characterized by pruritus and elevated liver enzymes, particularly during the third trimester. The symptoms and lab results (ALT 59 U/L and ALP 112 U/L) align with ICP, which is a common cause of itching and liver enzyme abnormalities in pregnant women.
Other Likely Diagnoses
- Pemphigoid Gestationis: An autoimmune skin disorder that occurs during pregnancy, characterized by itchy blisters and urticarial plaques. While less common than ICP, it's a plausible diagnosis given the skin symptoms.
- Polymorphic Eruption of Pregnancy (PEP): Previously known as pruritic urticarial papules and plaques of pregnancy (PUPPP), PEP is a common skin condition in pregnancy, presenting with itchy, red, and urticarial lesions, often starting in the abdominal striae.
Do Not Miss Diagnoses
- Acute Fatty Liver of Pregnancy (AFLP): A rare but potentially life-threatening condition that can present with similar liver enzyme elevations and pruritus. Early recognition is crucial due to its severe implications for both mother and fetus.
- Preeclampsia with HELLP Syndrome: Although less directly associated with itchy red nodules, preeclampsia and its complications can lead to liver enzyme elevations. The presence of hypertension and other systemic symptoms would guide towards this diagnosis.
Rare Diagnoses
- Cholestasis due to Other Causes: Such as primary biliary cirrhosis or drug-induced cholestasis, which could present with similar symptoms but are less common in the context of pregnancy.
- Prurigo of Pregnancy: A rare condition characterized by extremely itchy nodules, but it is not typically associated with significant liver enzyme abnormalities.