Differential Diagnosis
- Single most likely diagnosis
- Septic shock: The patient's presentation with a deep wound, incomplete antibiotic treatment, signs of inflammation (redness, tenderness, heat, swelling), fever, hypotension (BP 80/50) not responding to IV fluids, and leukocytosis strongly suggests septic shock. This condition occurs when an overwhelming infection leads to life-threatening low blood pressure and organ dysfunction.
- Other Likely diagnoses
- Severe sepsis: This diagnosis is closely related to septic shock and represents a spectrum of the same disease process. The patient's symptoms of fever, leukocytosis, and organ dysfunction (hypotension) are consistent with severe sepsis, which may progress to septic shock.
- Wound infection: Given the patient's history of a deep wound and incomplete treatment, a wound infection is likely. However, the systemic symptoms (fever, hypotension, leukocytosis) suggest that the infection has progressed beyond a localized wound infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Tetanus infection: Although less likely given the acute presentation and systemic symptoms, tetanus infection can occur in wounds, especially if not properly cleaned and treated. Tetanus can lead to severe muscle rigidity, spasms, and respiratory failure, making it a critical diagnosis not to miss.
- Rare diagnoses
- Necrotizing fasciitis: This is a rare but serious infection of the tissue beneath the skin and surrounding muscles and organs. It can occur after a wound and is characterized by severe pain, swelling, and necrosis of the affected area. The patient's symptoms of a severely inflamed hand and systemic illness could potentially be consistent with necrotizing fasciitis, although it is less likely than septic shock or severe sepsis.
- Gas gangrene: Another rare infection that can occur in wounds, gas gangrene is caused by Clostridium perfringens and is characterized by rapid progression of infection with gas production in tissues, leading to severe pain, swelling, and potentially life-threatening complications. The patient's presentation does not specifically suggest gas gangrene, but it remains a rare possibility in the context of a deep, inadequately treated wound.