mimics of infectious_diseases
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Mimics of infectious diseases
Zunaira Islam MD PGY1Kausar Akhtar, Infectious Disease
Orlando Regional Medical Center
Initial Infectious Dx
Cellulitis
Noninfectious Mimic Squamous cell carcinomaHyperthyroidism Pemphigus Sweet’s syndrome (neutrophilic skin infiltrationPyoderma grangrenosumFamilial Mediterranean FeverFamilial Hiberan FeverEosinophilic cellulitis (Wells syndrome) Erythromelalgia Carcinoma ErysepelatoidesSneddon Wilkinson diseaseForeign body granulomatous reaction Pustular psoriasisAcute generalized exanthematous pustulosis (drugs reaction)
DESQUAMATING SKIN LESIONS
• SJS (<10% BSA sloughing)
• SJS-TEN (10-30% BSA sloughing)
• TEN (>30% sloughing BSA)
• Erythema multiforme• DRESS (drug reaction
with eosinophilia and systemic signs)
• Staphylococcal scalded skin syndrome (fever, tenderness, erythema, mostly in neck, axilla, groin.
Skin desquamates in sheets. Do BIOPSY.
DRESS• severe, idiosyncratic multi-system reaction defined by the clinical
triad of fever, rash and internal organ involvement (e.g. hepatitis, myocarditis, nephritis or pneumonitis).1 - 8 weeks after exposure. Fever is a common early feature, usually preceeding a widespread and long-lasting papulopustular or erythematous skin eruption, which often progresses to exfoliative dermatitis.
• SJS
• Staph scalded skin syndrome
DVT
• Superficial thrombophlebitis
• Cellulitis
• Familial Mediterranean Fever
• Cellulitis
Still’s disease
• Salmon colored rash (95%)• Temperature spikes - Intermittent (100%)• Lymphdenopathy, spleenomegaly (85%)• Leukocytosis (85%) • Myalgias, arthragias (100%)• Pharyngitis• Pleuritis, pericarditis• Rarely meningitis (aseptic)• NSAIDS, steroids,
immunosuppressants
Iguazu waterfalls – Brazil / Argentina
Eosinophilic Cellulitis – WELLS syndrome
• Acute pruritic dermatitis, may have a few erythematous plaques.
• Resolve completely without scaring in 2-8 wks• Idiopathic myeloproliferative disorders • Steroids help.
Khone waterfalls – Laos (Africa)
Erythromelalgia
• Rare• Episodic burning pain• High skin temp• Bilateral redness of extremities• Usually feet … or hands• Worsened by: High fever,
exercise, dependant positions…
• Primary type: mutation of voltage gated Na channels
• Secondary type : myeloproliferative disorders, Bromocriptine, CaCB, pox-virus, SLE, HIV, DM, astrocytoma,
• SWEET SYDROME• Acute febrile neutrophillic
dermatoses • Papules coalesce ->
inflammatory plaques• Red, tender, on UE, face,
neck, back• Fever, conjunctivitis, oral
apthae, iritis, arthritis• Moderate neutrophilia• Dermal PMN infiltration
on Biopsy• 10% -> malignant
condition , mostly AML• Also ass with IBD, RA.• Steroids help
• Sneddon WilkinsonDiseaseSubcorneal pustular dermatosis
Usually in middle aged womenSerpinginous annular collection of sterile pustules.Usually in abdomen, axilla and groinAssociated with monoclonal gammopathy, autoimmune, other infectious processes. Rx: dapsone, sulfapyridine, oral corticosteroids, retinoids, colchicine, ketoconazole, minocycline, cyclosporine, mebhydroline, and infliximab
INFECTIOUS
Pneumonia
NON-INFECTIOUS MIMIC
Pulmonary embolus hemorrahagePulmonary alveolar proteinosisPulmonary Renal SyndromeWegener’s granulomatosis Goodpasture’s syndrome Aspiration syndromes Zenker’s diverticulum Lipid (nasal or lip emulsions) Metastatic cancer B.O.O.PChronic Eosinophilic pneumoniaHypersensitivity pneumonitisRadiation pneumonitisChemotherapy/drug induced Collagen vascular diseases associated Granulomatous VasculitisChurg Strauss (eosinophilic) syndromePulmonary vasculitis
INFECTIOUS
Endocarditis Culture negative endocarditis. - Partially treated bacterial - Zoonotic endocarditis -Bartonella quintasa, -Coxiella burnetti (Q fever) • Pyelonephritis:
NON-INFECTIOUS MIMIC
Myxoma FibroelastomaSarcoma ArteritisLibman Sacks endocarditis (SLE)Marantic (thrombotic) endocarditisRheumatoid nodules
XanthogranulomatosisHypernephroma Immune complex nephritis
INFECTIOUS
Osteomyelitis
Septic arthritis
Lymphadenitis
Misc:
NON-INFECTIOUS MIMIC
Sarcoma Metastatic carcinoma
Gout Pseudogout Reactive arthritis Rheumatoid arthritis Psoriatic arthritis
Lymphoma Carcinomatosis Angioimmunoblastic lymphadenopathy
SLE SarcoidosisRheumatologic, Autoimmune.
Infectious
Meningitis/meningo-encephalitis
Non Infectious Mimic
Acute: NSAID drugs SLE
Recurrent: Mollart’s meningitis(HSV?)SLETumorMigraine Dermoid cystFourth ventricle cyst
Chronic: Behcet’s disease Leptomeningeal metastas Primary CNS angitisSLE Sjogren syndrome Other: Sarcoidosis , liver failure, malignancy
Infectious
Sepsis
Non Infectious
Adrenal insufficiencyGI Bleed / hypotensionMIPEPancreatitisDiurectic inducedDKAVasculitisAnaphylaxisDrug overdose