What is the differential diagnosis (DD) of persistent ulcerated skin lesions at the site of intravenous chemotherapy injection in the arm, which have remained ulcerated for 9 months?

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Differential Diagnosis for Ulcerated Lesions of Skin Following Chemotherapy Injection

  • Single most likely diagnosis
    • Extravasation injury: This is the most likely diagnosis given the history of chemotherapy injection and the development of an ulcerated lesion at the site. Extravasation injuries occur when chemotherapy drugs leak out of the vein and into the surrounding tissue, causing damage and potentially leading to ulceration.
  • Other Likely diagnoses
    • Chemical burns: Chemotherapy drugs can cause chemical burns if they come into contact with skin, leading to ulceration and tissue damage.
    • Infection: Bacterial or fungal infections can cause ulcerated lesions, especially in immunocompromised patients undergoing chemotherapy.
    • Radiation dermatitis: If the patient has received radiation therapy in addition to chemotherapy, radiation dermatitis could be a possible cause of the ulcerated lesion.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Necrotizing fasciitis: This is a rare but life-threatening infection that can cause rapid tissue destruction and necrosis. It is essential to consider this diagnosis in any patient with a non-healing ulcerated lesion.
    • Malignant transformation: In rare cases, chronic wounds or ulcerated lesions can undergo malignant transformation, making it essential to monitor the lesion for any signs of cancer.
  • Rare diagnoses
    • Pyoderma gangrenosum: This is a rare skin condition characterized by the development of painful ulcers, often in response to trauma or injury.
    • Vasculitis: Certain types of vasculitis, such as leukocytoclastic vasculitis, can cause skin ulcers and should be considered in the differential diagnosis.
    • Scleroderma-like reaction: Some chemotherapy drugs can cause a scleroderma-like reaction, leading to skin thickening and ulceration.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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