Question

A patient hailing from Delhi presents with fever, arthralgia, and extensive petechial rash for 3 days. Lab investigations revealed a hemoglobin of 9 g/ dL, a white blood cell count of 9000 cells/mm3, a platelet count of 20000 cells/mm3, and a prolonged bleeding time. The clotting time was normal. What is the most likely diagnosis?

• A. Dengue
• B. Malaria
• C. Scrub typhus
• D. Typhoid

Answer 1

The Correct Option is A

The patient presents with symptoms including fever, arthralgia, and an extensive petechial rash alongside specific laboratory findings: hemoglobin of 9 g/dL, a white blood cell count of 9000 cells/mm³, a platelet count of 20000 cells/mm³, and a prolonged bleeding time with a normal clotting time. These clinical manifestations and laboratory results need to be correlated to arrive at a probable diagnosis.

The patient's symptoms and labs include:

• Fever
• Arthralgia (joint pain)
• Petechial rash (small red or purple spots)
• Thrombocytopenia (very low platelet count at 20000 cells/mm³)
• Prolonged bleeding time yet normal clotting time

Evaluation of Symptoms:

The presence of fever, rash, and joint pain can be seen in various infectious diseases, but when coupled with significant thrombocytopenia, the differential diagnosis narrows.

Consideration of Options:

• Dengue: Dengue fever is characterized by high fever, joint pain, rash, and notably, significant thrombocytopenia. The combination of prolonged bleeding time with normal clotting (indicative of platelet dysfunction) aligns with dengue. Furthermore, Delhi is an endemic area for dengue.
• Malaria: Malaria often presents with fever and may cause thrombocytopenia but typically doesn't cause a petechial rash or specific bleeding characteristics as described.
• Scrub typhus: Often presents with fever and rash but is less commonly associated with such a profound drop in platelet count.
• Typhoid: Usually causes sustained fever and abdominal symptoms but does not typically produce a petechial rash or significant thrombocytopenia.

Conclusion: Based on the clinical presentation and laboratory findings, the most likely diagnosis for this patient is Dengue. The presence of fever, rash, and joint pain in conjunction with severe thrombocytopenia and a bleeding time issue is highly indicative of dengue fever.