Differential Diagnosis for 57 year old female with blood shot eyes, red skin
- Single most likely diagnosis
- Vancomycin-induced Red Man Syndrome: This condition is a common adverse reaction to vancomycin, characterized by flushing and erythema of the upper body, which can occur within minutes to hours after the start of the infusion. The fact that the patient was already on vancomycin for a day and the skin turned red after initiation of the antibiotic supports this diagnosis.
- Other Likely diagnoses
- Allergic reaction to tube feeds: Although less common, an allergic reaction to the components of the tube feeds could cause a similar presentation, including red skin and potentially blood shot eyes if the reaction is severe.
- Sepsis or systemic infection: Given the patient's intubated status and recent initiation of vancomycin, an underlying infection could be causing a systemic inflammatory response, leading to red skin and other symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Anaphylaxis: Although the presentation might not fully align with typical anaphylaxis symptoms (e.g., hypotension, bronchospasm), any severe allergic reaction could potentially progress to anaphylaxis, which is life-threatening and requires immediate intervention.
- Toxic Epidermal Necrolysis (TEN) or Stevens-Johnson Syndrome (SJS): These are severe skin and mucous membrane disorders, usually caused by medications. They can present with skin redness and eye involvement, among other symptoms, and are medical emergencies due to their high mortality rate.
- Rare diagnoses
- Erythema multiforme: A skin condition characterized by target lesions, which could be considered in the differential for red skin, although it less commonly presents with the diffuse redness described.
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A rare but serious condition usually associated with certain medications, characterized by a rash, fever, and internal organ involvement. It could be a consideration given the patient's recent start of vancomycin, although it is less common than other reactions.