Differential Diagnosis for Patient with Self-Injected Steroids and Testosterone
Single Most Likely Diagnosis
- Sterile abscess or injection site reaction: This is the most likely diagnosis given the patient's history of self-injecting steroids and testosterone into the gluteal area, which can cause a localized reaction leading to swelling and redness without an organized collection of pus.
Other Likely Diagnoses
- Cellulitis: Bacterial infection of the skin and subcutaneous tissue is possible, especially if the injection technique was not sterile, leading to redness, swelling, and warmth of the affected area.
- Lipodermatosclerosis: This condition, characterized by inflammation and scarring of subcutaneous fat, could be a result of repeated injections into the same area, leading to localized skin and fat changes.
- Granuloma formation: The body's reaction to foreign substances (like injected steroids) can lead to the formation of granulomas, which are areas of inflammation that can cause swelling and redness.
Do Not Miss Diagnoses
- Necrotizing fasciitis: Although less likely, this is a life-threatening condition that requires immediate attention. It involves a severe infection of the tissue beneath the skin and can be a complication of non-sterile injections.
- Gas gangrene: Another severe infection that could occur if the injection introduced Clostridium perfringens into the muscle, leading to rapid progression of disease with severe pain, swelling, and gas production in the tissues.
- Septic arthritis or osteomyelitis: If the injection inadvertently entered the joint or bone, it could introduce bacteria, leading to septic arthritis or osteomyelitis, both of which are serious infections requiring prompt treatment.
Rare Diagnoses
- HIV or hepatitis transmission: If the needles or equipment used for injection were shared or contaminated, there's a risk of transmitting blood-borne pathogens like HIV or hepatitis.
- Squamous cell carcinoma: Long-term effects of repeated steroid injections could potentially lead to changes in the skin, including an increased risk of certain types of skin cancer, although this would be a very long-term complication.
- Foreign body reaction: Depending on the materials used for the injection (e.g., certain types of steroid preparations), there could be a foreign body reaction, although this is less common with standard steroid and testosterone preparations.