Misdiagnosis of Rash

Misdiagnosis and Rash

Poorly healing leg rashes a classic sign of chronic disease: Recurring leg rashes, or poorly healing leg rashes, are a classic sign of undiagnosed diabetes, particularly of Type 2 diabetes, but also Type 1 diabetes. They can also occur with poor diabetic control. However, there are many other possible causes of leg rashes. See causes of leg rash or misdiagnosis of diabetes.

Psoriasis often undiagnosed cause of skin symptoms in children: Children who suffer from the skin disorder called psoriasis can often go undiagnosed. The main problem is that psoriasis is rare in children, and not often seen by physicians for this reason. children may receive treatment for fungal skin infections. See misdiagnosis of psoriasis or symptoms of psoriasis.

Dermatomyositis in breast cancer: Dermatomyositis is a serious connective-tissue disease related to polymyositis that is characterized by inflammation of the muscles and the skin. The cause is unknown, but it may result from either a viral infection or an autoimmune reaction. Some cases of dermatomyositis may overlap with another autoimmune disease such as lupus, scleroderma, or vasculitis The main symptoms include skin rash and symmetric proximal muscle weakness which may be accompanied by pain. Skin findings occur in DM but not PM and are generally present at diagnosis. It must be differentiated from other conditions such as Inclusion body myositis which can be done on biopsy. It is also a part of the paraneoplastic conditions which occurs in cases of breast cancers.

Rash of Dengue can be misdiagnosed: Dengue fever also known as 'breakbone fever' is a mosquito borne viral infection. The most common clinical presentation is that of severe headache, eye pain, fever, joint pain and the maculopapular rubelliform rash which can lead to a chance of misdiagnosis. There are several conditions from which dengue has to differentiated some of them being Leptospirosis, measles, malaria, yellow fever, meningoencephalitis etc. No specific treatment of dengue is available. Early institution of supportive treatment is the key to management of patients with dengue of all forms.

Toxic shock syndrome in women: Toxic shock syndrome is a toxin mediated multisysyem disease precipitated by infection with staphylococcus aureus or either group A streptococcus. It commonly occurs in women who use tampons. It is characterised by a rapid onset of high fever, hypotension, rash, myalgia and vomiting. Mortality is high. Quick recognition of the syndrome is important for enabling appropriate and prompt treatment. Patients who do recover from the syndrome are at a risk of developing recurrent episodes. It must be differentiated from cellulitis, gas gangrene, pneumonia, septic shock etc.

Painful throat- look for infectious mononucleosis: Infectious mononucleosis must be considered in 15- 25 year old patients presenting with a painful throat. The patient presents with slow onset of malaise, fever, headache sore throat and rash. It can be misdiagnosed as HIV primary infection, tonsillitis, viral hepatitis and leukaemia. Paul Bunnell test is one of the important lab tests commonly done along with white cell count and blood smear. There is no specific treatment and supportive measures will suffice. It usually runs an uncomplicated course.

Cryptogenic fibrosing alveolitis non specific presentation: Cryptogenic fibrosing alveoloitis is a chronic lung disease occurring due to the inflammation of the alveoli. The aetiology and pathogenesis are not known. The commonest symptoms are shortness of breath and dry cough. Extra pulmonary features such as muscle pain, arthralgia and skin rashes may also occur. Due to its non specific nature of presentation it maybe misdiagnosed as heart failure, COPD, sarcoidosis, pulmonary embolism, lymphangitis carcinomatosis and extrinsic allergic alveoloitis.

Kawasaki's disease can be misdiagnosed as common childhood ailments: Kawasaki’s disease is a febrile disorder affecting children below 5 years. It affects mainly the blood vessels but can also affect the mucous membrane, lymph nodes and skin. Kawasaki's disease is a self limiting condition but early diagnosis and treatment prevents the development of fatal complications. Since there are no specific tests to diagnose Kawasaki's disease, diagnosis is made by exclusion of other common childhood conditions which have similar symptoms. It can be misdiagnosed as Scarlet Fever, Measles, Stevens Johnson Syndrome, Juvenile Rheumatoid Arthritis, Toxic Shock Syndrome. A diagnosis of Kawasaki's Disease can be made if the fever lasts for five or more days and the child has accompanying signs and symptoms.

Sunburn or general photosensitivity?: Sunburn is normally caused by UV-B radiation which penetrates the epidermis and the superficial dermis which release substances such as leucotrienes and histamines can cause redness and pain. Severe sunburn may develop on relatively dull days because thin clouds filter UV- B poorly. The clinical presentations may be mild eythema with minimal discomfort to severe burns such as vesicles, bullae, hypotension and fever. It must be differentiated from that of genearl sensitivity caused by certain drugs such as thiazides, sulphonamides, NSAID's and grisseofluvin, photocontact dermatitis and acute systemic lupus erythematosus.

More about Misdiagnosis

• Causes of Rash
• Misdiagnosis Overview
• How Common is Misdiagnosis?
• Over-Diagnosed Diseases
• Under-Diagnosed Diseases
• Types of Misdiagnosis
• Wrong Type Misdiagnosis
• Why Does Misdiagnosis Occur?
• Difficult Diseases to Diagnose
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