Differential Diagnosis for Bilateral Foot Redness in Alcoholic with Warmth

• Single most likely diagnosis
  • Cellulitis: This is the most likely diagnosis given the symptoms of bilateral foot redness, warmth, and the patient's history of alcoholism. Cellulitis is a common infection of the skin and subcutaneous tissues, often caused by streptococcal or staphylococcal bacteria, and can be more prevalent in individuals with compromised immune systems, such as alcoholics.
• Other Likely diagnoses
  • Eczema or dermatitis: These conditions can cause redness and warmth, especially if the patient has been exposed to irritants or allergens. However, they might not fully explain the warmth unless there's a significant inflammatory component.
  • Fungal infections (e.g., athlete's foot): While these can cause redness, they are typically more localized and might not present with the same level of warmth as bacterial infections.
  • Vasculitis: Certain types of vasculitis can cause skin redness and warmth, but this would be less common and might be accompanied by other systemic symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Necrotizing fasciitis: Although rare, this condition is a medical emergency that can present with similar symptoms of redness and warmth but is characterized by severe pain out of proportion to the physical findings and can rapidly progress to sepsis and death if not promptly treated.
  • Deep vein thrombosis (DVT): While DVT typically presents with unilateral symptoms, in rare cases, it can be bilateral. The warmth and redness could be mistaken for a skin infection, but DVT requires immediate anticoagulation to prevent pulmonary embolism.
  • Septic arthritis: If the redness and warmth are localized around a joint, septic arthritis should be considered, especially in an immunocompromised patient. This condition requires prompt diagnosis and treatment to preserve joint function.
• Rare diagnoses
  • Erythromelalgia: A disorder characterized by burning pain, heat, and redness in the hands and feet, which could potentially be confused with an infectious process. It's more common in patients with certain myeloproliferative disorders.
  • Complex regional pain syndrome (CRPS): This condition can cause redness, warmth, and pain in one or more limbs but is typically preceded by trauma or injury and has a distinct set of diagnostic criteria.