Differential Diagnosis

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Differential Diagnosis. Staphylococcus aureus. Mycobacterium marinum. Vibrio vulnificus. Ecthyma gangrensum. Aeromonas. Deep fungal infection. Anthrax. Erysipeloid. Orf. Tularemia. vasculitis. Diagnostic Procedure(s) and Result(s). - PowerPoint PPT Presentation

Text of Differential Diagnosis

  • Differential Diagnosis

  • Staphylococcus aureus

  • Mycobacterium marinum

  • Vibrio vulnificus

  • Ecthyma gangrensum

  • Aeromonas

  • Deep fungal infection

  • Anthrax

  • Erysipeloid

  • Orf

  • Tularemia

  • vasculitis

  • Diagnostic Procedure(s) and Result(s)Cultures of the lesion on the left leg and right hand, obtained on admission, grew rare methicillin-susceptible Staphylococcus aureus colonies; the culture of the leg also grew Enterococcus in the thioglycollate broth tube, which was thought to be a contaminant.

  • Cultures of the leg and right hand obtained in the operating room were sterile.

  • All other wound cultures, including for fungi and mycobacteria, were sterile, as were blood cultures. Testing for 1, 3 beta D glucan was negative.

  • Indirect immunofluorescence testing for anti-neutrophil cytoplasm antibodies (ANCA), serum protein electrophoresis and testing for lupus anticoagulant and syphilis were also negative.

  • Histopathological examinationrevealed normal tissue, as well as an intraepidermal blister, a dense dermal acute inflammatory infiltrate and tissue necrosis.

  • normal skin

  • dense acute inflammatory infiltrate

  • epidermal necrosis and an intraepidermal blister

  • Final Diagnosis

  • Pyoderma gangrenosum of the hands and left leg

  • Physical findings, post-operatively.

  • Physical findings, post-operatively.

  • Pyoderma gangrenosum is an idiopathic inflammatory disease that is often mistaken for an infectious process.

  • Diagnosis of this condition is based upon clinical history, pathology, and exclusion of other diseases that cause erosive or ulcerative skin lesions.

  • Pyoderma gangrenosum

  • Pyoderma gangrenosum

  • Pyoderma gangrenosum

  • While an underlying systemic disease such as inflammatory bowel disease, myeloproliferative disorder, or inflammatory arthritis is found in approximately 50% of cases of pyoderma gangrenosum, this disease has also been associated with trauma (including burns) and surgery.

  • It is important to consider this disease in patients with non-healing wounds and obtain early dermatologic consultation whenever possible, because surgical intervention, including debridement, may exacerbate pyoderma gangrenosum and lead to worsening ulceration.

  • While there is no published algorithm for the treatment of pyoderma gangrenosum, the literature suggests the use of prolonged systemic glucocorticoid therapy;

  • A subset of patients requires the use of other immunomodulators (e.g. cyclosporine, thalidomide, and tumor necrosis factor (TNF)-alpha blockers such as infliximab).

  • Differential Diagnosis

  • ecthyma gangrenosum

  • ecthyma gangrenosum

  • ecthyma gangrenosum

  • vibrio vulnificus

  • vibrio vulnificus

  • vibrio vulnificus

  • mycobacterium marinum

  • mycobacterium marinum

  • mycobacterium marinum

  • Orf

  • Anthrax