Differential Diagnosis for Scrotal Ulcer
Single Most Likely Diagnosis
- Chronic cutaneous leishmaniasis: This condition is characterized by a chronic, painful ulcer with a white discharge and can cause significant discomfort. The long duration of symptoms (approximately 5 years) and the description of the ulcer support this diagnosis.
Other Likely Diagnoses
- Squamous cell carcinoma: A long-standing, painful ulcer with white discharge could be a sign of squamous cell carcinoma, especially if the surrounding skin is pink and tender to touch.
- Eczema or contact dermatitis: Chronic eczema or contact dermatitis could lead to a painful, cracked scrotal ulcer with white discharge, especially if the skin is sensitive to touch.
- Fungal infections (e.g., candidiasis): Fungal infections can cause painful, cracked skin with white discharge, particularly in warm, moist areas like the scrotum.
Do Not Miss Diagnoses
- Squamous cell carcinoma with underlying lymphoma: Although less likely, it's crucial to rule out underlying lymphoma, which could present with a painful scrotal ulcer and white discharge.
- Cutaneous tuberculosis: This condition can cause chronic, painful ulcers with white discharge and should be considered, especially if the patient has a history of tuberculosis exposure.
- Syphilis (tertiary stage): Tertiary syphilis can cause painful ulcers, and although less common, it's essential to consider this diagnosis due to its potential severity and impact on public health.
Rare Diagnoses
- Granuloma inguinale (donovanosis): A rare, chronic bacterial infection that can cause painful, beefy-red ulcers with white discharge, although it's less likely given the description of pink skin.
- Lymphogranuloma venereum: A rare, sexually transmitted infection that can cause painful ulcers, although it's typically accompanied by other symptoms like lymphadenopathy.
- Cutaneous amoebiasis: A rare, parasitic infection that can cause painful ulcers with white discharge, although it's uncommon in this context.