Mimics of infectious_diseases


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Mimics of infectious_diseases

  1. 1. Mimics of infectious diseases Zunaira Islam MD PGY1 Kausar Akhtar, Infectious Disease Orlando Regional Medical Center
  2. 2. Initial Infectious Dx Cellulitis Noninfectious Mimic Squamous cell carcinoma Hyperthyroidism Pemphigus Sweet ’s syndrome (neutrophilic skin infiltration Pyoderma grangrenosum Familial Mediterranean Fever Familial Hiberan Fever Eosinophilic cellulitis (Wells syndrome) Erythromelalgia Carcinoma Erysepelatoides Sneddon Wilkinson disease Foreign body granulomatous reaction Pustular psoriasis Acute generalized exanthematous pustulosis (drugs reaction)
  3. 3. DESQUAMATING SKIN LESIONS <ul><ul><li>SJS (<10% BSA sloughing) </li></ul></ul><ul><ul><li>SJS-TEN (10-30% BSA sloughing) </li></ul></ul><ul><ul><li>TEN (>30% sloughing BSA) </li></ul></ul><ul><ul><li>Erythema multiforme </li></ul></ul><ul><ul><li>DRESS (drug reaction with eosinophilia and systemic signs) </li></ul></ul><ul><ul><li>Staphylococcal scalded skin syndrome (fever, tenderness, erythema, mostly in neck, axilla, groin. </li></ul></ul><ul><li>Skin desquamates in sheets. Do BIOPSY. </li></ul>
  4. 4. DRESS <ul><ul><li>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.  </li></ul></ul>
  5. 5. <ul><ul><li>SJS </li></ul></ul><ul><ul><li>Staph scalded skin syndrome </li></ul></ul>
  6. 6. <ul><ul><li>Superficial thrombophlebitis </li></ul></ul>DVT <ul><ul><li>Cellulitis </li></ul></ul>
  7. 7. <ul><ul><li>Familial Mediterranean Fever </li></ul></ul><ul><ul><li>Cellulitis </li></ul></ul>
  8. 9. Still ’s disease <ul><ul><li>S almon colored rash (95%) </li></ul></ul><ul><ul><li>T emperature spikes - I ntermittent (100%) </li></ul></ul><ul><ul><li>L ymphdenopathy, spleenomegaly (85%) </li></ul></ul><ul><ul><li>L eukocytosis (85%) </li></ul></ul><ul><ul><li>Myalgias, arthragias (100%) </li></ul></ul><ul><ul><li>Pharyngitis </li></ul></ul><ul><ul><li>Pleuritis, pericarditis </li></ul></ul><ul><ul><li>Rarely meningitis (aseptic) </li></ul></ul><ul><ul><li>NSAIDS, steroids, </li></ul></ul><ul><li>immunosuppressants </li></ul>
  9. 10. Iguazu waterfalls – Brazil / Argentina
  10. 11. Eosinophilic Cellulitis – WELLS syndrome <ul><ul><li>Acute pruritic dermatitis, may have a few erythematous plaques. </li></ul></ul><ul><ul><li>Resolve completely without scaring in 2-8 wks </li></ul></ul><ul><ul><li>Idiopathic myeloproliferative disorders </li></ul></ul><ul><ul><li>Steroids help. </li></ul></ul>
  11. 12. Khone waterfalls – Laos (Africa)
  12. 13. Erythromelalgia <ul><ul><li>Rare </li></ul></ul><ul><ul><li>Episodic burning pain </li></ul></ul><ul><ul><li>High skin temp </li></ul></ul><ul><ul><li>Bilateral redness of extremities </li></ul></ul><ul><ul><li>Usually feet … or hands </li></ul></ul><ul><ul><li>Worsened by: High fever, exercise, dependant positions… </li></ul></ul><ul><ul><li>Primary type: mutation of voltage gated Na channels </li></ul></ul><ul><ul><li>Secondary type : myeloproliferative disorders, Bromocriptine, CaCB, pox-virus, SLE, HIV, DM, astrocytoma, </li></ul></ul>
  13. 15. <ul><ul><li>SWEET SYDROME </li></ul></ul><ul><ul><li>Acute febrile neutrophillic dermatoses </li></ul></ul><ul><ul><li>Papules coalesce -> inflammatory plaques </li></ul></ul><ul><ul><li>Red, tender, on UE, face, neck, back </li></ul></ul><ul><ul><li>Fever, conjunctivitis, oral apthae, iritis, arthritis </li></ul></ul><ul><ul><li>Moderate neutrophilia </li></ul></ul><ul><ul><li>Dermal PMN infiltration on Biopsy </li></ul></ul><ul><ul><li>10% -> malignant condition , mostly AML </li></ul></ul><ul><ul><li>Also ass with IBD, RA. </li></ul></ul><ul><ul><li>Steroids help </li></ul></ul>
  14. 16. <ul><ul><li>Sneddon Wilkinson </li></ul></ul><ul><li>Disease </li></ul><ul><li>Subcorneal pustular dermatosis </li></ul><ul><li>Usually in middle aged women </li></ul><ul><li>Serpinginous annular collection of sterile pustules. </li></ul><ul><li>Usually in abdomen, axilla and groin </li></ul><ul><li>Associated with monoclonal gammopathy, autoimmune, other infectious processes. </li></ul><ul><li>Rx: dapsone, sulfapyridine, oral corticosteroids, retinoids, colchicine, ketoconazole, minocycline, cyclosporine, mebhydroline, and infliximab </li></ul>
  15. 18. INFECTIOUS Pneumonia NON-INFECTIOUS MIMIC Pulmonary embolus hemorrahage Pulmonary alveolar proteinosis Pulmonary Renal Syndrome Wegener ’s granulomatosis Goodpasture ’s syndrome Aspiration syndromes Zenker ’s diverticulum Lipid (nasal or lip emulsions) Metastatic cancer B.O.O.P Chronic Eosinophilic pneumonia Hypersensitivity pneumonitis Radiation pneumonitis Chemotherapy/drug induced Collagen vascular diseases associated Granulomatous Vasculitis Churg Strauss (eosinophilic) syndrome Pulmonary vasculitis
  16. 20. <ul><li>INFECTIOUS </li></ul><ul><li>Endocarditis </li></ul><ul><li>Culture negative endocarditis. </li></ul><ul><li>- Partially treated bacterial </li></ul><ul><li>- Zoonotic endocarditis </li></ul><ul><li>-Bartonella quintasa, </li></ul><ul><li>-Coxiella burnetti (Q fever) </li></ul><ul><ul><li>Pyelonephritis: </li></ul></ul>NON-INFECTIOUS MIMIC Myxoma Fibroelastoma Sarcoma Arteritis Libman Sacks endocarditis (SLE) Marantic (thrombotic) endocarditis Rheumatoid nodules Xanthogranulomatosis Hypernephroma Immune complex nephritis
  17. 21. 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 Sarcoidosis Rheumatologic, Autoimmune.
  18. 25. Infectious Meningitis/meningo-encephalitis Non Infectious Mimic Acute: NSAID drugs SLE Recurrent: Mollart ’s meningitis(HSV?) SLE Tumor Migraine Dermoid cyst Fourth ventricle cyst Chronic: Behcet ’s disease Leptomeningeal metastas Primary CNS angitis SLE Sjogren syndrome Other: Sarcoidosis , liver failure, malignancy
  19. 26. Infectious Sepsis Non Infectious Adrenal insufficiency GI Bleed / hypotension MI PE Pancreatitis Diurectic induced DKA Vasculitis Anaphylaxis Drug overdose