Differential Diagnosis for a 54-year-old man with a history of ulcerative colitis and intraabdominal abscess, presenting with painful skin lesions on the neck
- Single most likely diagnosis
- Pyoderma gangrenosum: This is a skin condition often associated with inflammatory bowel diseases like ulcerative colitis. The painful skin lesions, especially in the context of a patient with ulcerative colitis, make this a highly plausible diagnosis.
- Other Likely diagnoses
- Skin metastasis or seeding from an intraabdominal source: Given the patient's history of an intraabdominal abscess, it's possible that the skin lesions could be a result of bacterial seeding from the abscess.
- Sweet syndrome (Acute febrile neutrophilic dermatosis): This condition can be associated with inflammatory bowel disease and is characterized by fever, neutrophilia, and tender erythematous skin lesions, which could fit the patient's presentation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Necrotizing fasciitis: Although less common, this is a life-threatening condition that requires immediate attention. The presence of painful skin lesions, especially if accompanied by signs of infection or sepsis, should prompt consideration of this diagnosis.
- Septic emboli: In the context of an intraabdominal abscess, there's a risk of septic emboli, which could manifest as skin lesions among other symptoms. This would be a critical diagnosis to consider due to its high mortality rate if not promptly treated.
- Rare diagnoses
- Erythema nodosum: While this condition can be associated with inflammatory bowel disease, it typically presents with painful nodules on the lower extremities, making it less likely given the neck involvement.
- Behçet's disease: This rare condition involves inflammation of the blood vessels and can present with a variety of symptoms including skin lesions. However, its rarity and the presence of other more likely explanations make it a less probable diagnosis in this case.