Differential Diagnosis
The patient's symptoms of abscess formation, double vision, fever, chills, and swelling of fingers suggest a complex and potentially serious condition. Here's a differential diagnosis organized into categories:
- Single most likely diagnosis
- Myiasis with secondary infection and sepsis: The presence of an abscess on the back of the head, possibly due to fly infestation (myiasis), along with systemic symptoms like fever, chills, and swelling of fingers, could indicate a secondary bacterial infection leading to sepsis. Double vision could be a result of the infection spreading to the nervous system or a sign of increased intracranial pressure.
- Other Likely diagnoses
- Cellulitis or abscess with bacteremia: A bacterial infection causing cellulitis or an abscess could lead to bacteremia, explaining the fever, chills, and swelling of fingers. Double vision might be related to a separate issue or a complication of the infection.
- Lyme disease: This tick-borne illness can cause a range of symptoms, including fever, chills, swelling of fingers (due to arthritis), and neurological issues like double vision, especially in later stages.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Meningitis or brain abscess: Although less likely, these conditions are medical emergencies. The abscess on the head could be a sign of an infection that has spread to the brain, causing meningitis or a brain abscess, which would explain the double vision and could lead to severe complications or death if not promptly treated.
- Endocarditis: This infection of the heart valves can cause fever, chills, and systemic symptoms. While less directly related to the abscess or double vision, it's a condition that could lead to severe complications, including embolic events that might cause neurological symptoms.
- Rare diagnoses
- Erdheim-Chester disease: A rare form of histiocytosis that can cause a wide range of symptoms, including neurological issues and systemic inflammation, but it would be an unusual cause of the specific combination of symptoms described.
- Neurosyphilis: In its tertiary stage, syphilis can cause a variety of neurological symptoms, including double vision, but the other symptoms like abscess formation and finger swelling would be less typical presentations.