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