The Infectious Disease Diagnosis by Michael David & Jean-Luc Benoit

Author:Michael David & Jean-Luc Benoit
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

The differential diagnosis of palmar skin lesions with or without fever is presented in Table 24.3. The differential for our patient was quite broad initially although it could be narrowed on the basis of signs, symptoms, and history. Although another fungal infection was possible, the skin lesions of Blastomyces tend to have purulent drainage, unlike his dry, papular lesions. The skin lesions, with symptoms of central nervous system (CNS) involvement, made most other fungal pathogens unlikely. Tuberculosis or non-tubercular Mycobacteria was possible, but would be unlikely in an immunocompetent host, and eosinophilia would not be common. Cryptococcal meningitis and skin lesions would also be unlikely in this host although Cryptococcus gattii has been reported to cause meningitis in immunocompetent patients in the US Pacific northwest and the region around Vancouver Island in Canada. Viral pathogens can cause aseptic meningitis and a rash, but the observed papular skin lesions would have been quite unusual for a viral infection. Lesions on the palms and soles should always raise the question of Rocky Mountain spotted fever, meningococcemia, or syphilis. However, there were no tick exposures, and the morphology of the skin lesions was not at all typical of a rickettsial infection. There were no known recent sexual exposures, and testing for syphilis was negative, making secondary syphilis very unlikely. Meningococcemia usually has a much more fulminant presentation with sepsis, and the lesions are often petechial or purpuric, unlike the papular lesions in our patient.Table 24.3Differential diagnosis for palm and sole skin lesions with or without fever (etiologies in bold text are more common)

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