Differential Diagnosis for Right Wrist Pain
The patient presents with right wrist pain, swelling, redness, warmth to touch, and discomfort with touch, without any recent trauma or injury. Considering the patient's symptoms and medical history, the following differential diagnoses are possible:
- Single most likely diagnosis
- Cellulitis: The presence of erythema, warmth, swelling, and tenderness to touch, particularly on the palmar side of the wrist, is consistent with cellulitis, a common bacterial skin infection. The absence of fever does not rule out this diagnosis.
- Other Likely diagnoses
- Insect bite reaction: Despite the patient's denial of insect bites, the raised pinpoint area consistent with a bite suggests this possibility. The reaction could be causing the localized erythema, warmth, and swelling.
- Contact dermatitis: Given the patient's history of psoriasis, they might be more prone to skin reactions, including contact dermatitis, which could cause similar symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic arthritis: Although the patient denies any trauma, septic arthritis is a serious condition that requires prompt diagnosis and treatment. The presence of swelling, redness, and warmth, especially in the context of a patient with multiple comorbidities, makes this a critical diagnosis not to miss.
- Necrotizing fasciitis: This is a rare but life-threatening condition characterized by rapid progression of infection and necrosis of the fascia. The patient's symptoms of erythema, warmth, and swelling, along with the absence of trauma, should raise suspicion for this condition.
- Rare diagnoses
- Gout: Although the patient has a remote history of gout, the absence of recent high purine food intake and the lack of characteristic joint involvement (e.g., the big toe) make this diagnosis less likely. However, it cannot be entirely ruled out without further evaluation.
- Rheumatoid arthritis flare: The patient's symptoms could be consistent with a rheumatoid arthritis flare, but there is no mention of a history of rheumatoid arthritis or other joint involvement, making this diagnosis less likely.