Differential Diagnosis for Oral and Acral Lesions
As a dermatologist, I'll provide a differential diagnosis for the patient's condition, categorizing the possibilities into the following groups:
- Single Most Likely Diagnosis
- Hand, Foot, and Mouth Disease (HFMD): This is a common viral illness characterized by painful lesions on the palms, soles, and oral mucosa. The acute onset and lack of systemic manifestations support this diagnosis.
- Other Likely Diagnoses
- Herpes Simplex Virus (HSV) infection: HSV can cause painful oral and acral lesions, although it's less common to have simultaneous involvement of palms, soles, and oral mucosa.
- Eczema herpeticum: A disseminated HSV infection in patients with atopic dermatitis, which could present with painful lesions on the hands, feet, and mouth.
- Aphthous stomatitis with secondary skin involvement: Although less common, aphthous ulcers can be accompanied by skin lesions on the hands and feet.
- Do Not Miss Diagnoses
- Primary Herpes Simplex Virus (HSV) infection: Although less likely, primary HSV infection can be severe and require antiviral treatment.
- Varicella-Zoster Virus (VZV) infection: Reactivation of VZV can cause herpes zoster, which may present with painful lesions on the hands, feet, or mouth, especially in immunocompromised patients.
- Rare Diagnoses
- Enterovirus 71 (EV-71) infection: A rare but potentially severe cause of HFMD, which can present with similar symptoms.
- Pemphigus vulgaris: An autoimmune blistering disease that can cause oral and skin lesions, although it's less common to have acral involvement.
- Paraneoplastic pemphigus: A rare autoimmune disorder associated with underlying malignancies, which can cause severe oral and skin lesions.
To further narrow down the diagnosis, I would like to ask a few questions:
- What is the patient's age and medical history?
- Are there any associated symptoms, such as fever, fatigue, or lymphadenopathy?
- Have you performed any diagnostic tests, such as viral cultures or biopsies?
- Are the lesions vesicular, bullous, or ulcerative in nature?