Differential Diagnosis for Sulfur Discharge

Single Most Likely Diagnosis

• Actinomycosis: This condition is characterized by the formation of abscesses that drain through sinus tracts, often with the presence of sulfur granules. The clinical presentation of sulfur discharge strongly suggests actinomycosis, making it the most likely diagnosis.

Other Likely Diagnoses

• Tuberculosis: Although less common, tuberculosis can cause chronic infections with discharge, and in some cases, the discharge may resemble sulfur due to the presence of caseous material.
• Nocardiosis: This bacterial infection can cause abscesses and sinus tracts, potentially leading to a discharge that might be mistaken for sulfur.
• Chronic bacterial infections (e.g., Staphylococcus aureus, Streptococcus): Certain chronic bacterial infections can lead to the formation of abscesses and sinus tracts, resulting in a discharge that could be confused with sulfur.

Do Not Miss Diagnoses

• Malignancy (e.g., squamous cell carcinoma): Although less likely, malignancies can cause chronic discharge and should not be missed due to their potential for severe consequences if left untreated.
• Deep fungal infections (e.g., mycetoma): These infections can cause chronic discharge and the formation of sinus tracts, similar to actinomycosis, and are critical not to miss due to their difficulty in treatment.

Rare Diagnoses

• Parasitic infections (e.g., amoebiasis, leishmaniasis): Certain parasitic infections can cause chronic discharge and should be considered in the differential diagnosis, especially in patients with a history of travel to endemic areas.
• Granulomatosis with polyangiitis (formerly Wegener's granulomatosis): This autoimmune disorder can cause chronic infections and discharge, although it is a rare condition.