Differential Diagnosis
The patient's symptoms suggest an infectious or inflammatory process. Here's a breakdown of possible diagnoses:
- Single most likely diagnosis
- Erysipelas: This is a type of skin infection that typically starts on the face, often around the bridge of the nose or the cheeks. It is characterized by a well-defined, erythematous, edematous, smooth, shiny, and hot rash, which matches the patient's symptoms. The presence of fever further supports this diagnosis.
- Other Likely diagnoses
- Cellulitis: While cellulitis can present similarly to erysipelas, it tends to have less well-defined borders and can occur on various parts of the body, not just the face. However, given the location and description, it remains a plausible consideration.
- Contact Dermatitis: This could be a possibility if the patient has come into contact with an allergen or irritant, but the presence of fever and the specific description of the rash make it less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Necrotizing Fasciitis: Although rare and less likely given the initial presentation, necrotizing fasciitis is a life-threatening condition that requires immediate attention. It can start with symptoms similar to cellulitis or erysipelas but rapidly progresses.
- Lyme Disease: If the patient has been exposed to ticks, Lyme disease could be a consideration, especially if the rash is a "bull's-eye" rash (erythema migrans). However, the description provided does not specifically mention this pattern.
- Rare diagnoses
- Lupus Erythematosus: This autoimmune disease can cause a butterfly-shaped rash across the cheeks and nose, but it typically does not present with fever and such acute onset.
- Sarcoidosis: This condition can cause skin lesions, but they are usually not as acute or accompanied by fever in the initial stages.
- Erythema Multiforme: This is an immune-mediated disorder that can cause target-like lesions, often on the extremities and sometimes on the face. It can be triggered by infections or medications but is less likely given the specific description of the rash and its progression.