Differential Diagnosis
- Single most likely diagnosis
- Myiasis due to Botfly infestation: The patient's history of exposure to bugs while cleaning a refrigerator, followed by the development of a swollen area on the back of her head with a dark indentation, is consistent with a Botfly infestation. The presence of a pus-filled area and systemic symptoms such as fever and fatigue further support this diagnosis.
- Other Likely diagnoses
- Cellulitis or abscess: The patient's symptoms of a swollen, pus-filled area with fever and fatigue could also be consistent with a bacterial infection such as cellulitis or an abscess.
- Insect bite reaction: The patient's exposure to bugs could have resulted in an allergic reaction or infection from an insect bite, which could cause similar symptoms.
- Folliculitis or furunculosis: The patient's symptoms could also be consistent with a bacterial infection of the hair follicle, such as folliculitis or furunculosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Meningitis: The patient's symptoms of fever, headache, and double vision could be consistent with meningitis, which is a life-threatening condition that requires prompt diagnosis and treatment.
- Brain abscess: The patient's symptoms of fever, headache, and double vision could also be consistent with a brain abscess, which is a serious and potentially life-threatening condition.
- Tick-borne illnesses (e.g. Rocky Mountain spotted fever): Although the patient's history does not specifically mention tick exposure, tick-borne illnesses can present with similar symptoms and are potentially life-threatening if not treated promptly.
- Rare diagnoses
- Leishmaniasis: This is a rare parasitic infection that can cause skin lesions and systemic symptoms, but it is typically associated with travel to endemic areas.
- Mycobacterial infection: This is a rare bacterial infection that can cause skin lesions and systemic symptoms, but it is typically associated with immunocompromised individuals or specific exposures.