Differential Diagnosis for 31 F with Random Sores, Cellulitis, Sore Throats, Fatigue, Face Rash, and Hair Loss

• Single Most Likely Diagnosis
  • Atopic Dermatitis (Eczema) or Contact Dermatitis: Given the patient's history of seasonal allergies and symptoms of random sores on the breasts, cellulitis, face rash on the cheeks, and hair loss, atopic dermatitis or contact dermatitis could be a unifying diagnosis. These conditions are common in individuals with a history of allergies and can cause skin lesions, itching, and secondary infections like cellulitis. The face rash could be related to atopic dermatitis or contact dermatitis, especially if it's exacerbated by allergens or irritants.
• Other Likely Diagnoses
  • Impetigo: This is a highly contagious bacterial skin infection that could explain the sores and cellulitis on the breasts. It's common in individuals with compromised skin integrity, such as those with eczema.
  • Folliculitis: An inflammation of the hair follicles, which could explain the random sores and hair loss. It can be caused by bacterial or fungal infections.
  • Stress-Related or Hormonal Acne: The face rash could also be acne, exacerbated by stress (given her history of anxiety) or hormonal fluctuations.
  • Vasculitis: Although less likely given the negative workup for lupus, certain types of vasculitis (like leukocytoclastic vasculitis) could present with skin lesions and systemic symptoms.
• Do Not Miss Diagnoses
  • Lymphoma: Although the previous workup aimed to rule out lupus, lymphoma can present with a wide range of symptoms including fatigue, sore throats, and skin lesions. It's crucial to consider this diagnosis due to its potential severity.
  • Infectious Diseases (e.g., MRSA, Tuberculosis): These could explain recurrent infections and should be considered, especially if there's a history of exposure or if the patient is not responding to standard treatments.
  • HIV: Given the recurrent infections and fatigue, HIV should be considered, as it can present with a variety of symptoms including skin rashes and recurrent infections.
• Rare Diagnoses
  • Sjögren's Syndrome: An autoimmune disorder that could explain some of the patient's symptoms, including dry skin, fatigue, and possibly the face rash, although it's less common.
  • Dermatomyositis: An inflammatory disease characterized by skin rash and muscle weakness, which could explain some of the patient's symptoms, although it's rare and typically presents with more pronounced muscle symptoms.
  • Autoimmune Bullous Diseases (e.g., Pemphigus, Pemphigoid): These are rare autoimmune diseases that cause blistering of the skin and mucous membranes, which could potentially explain some of the patient's symptoms.