Differential Diagnosis for a 67-year-old Female with an Open Wound on Her Head Draining for One Year
- Single Most Likely Diagnosis
- Chronic wound or ulcer, possibly due to trauma, poor circulation, or pressure sore: This is the most likely diagnosis given the duration of the wound and its failure to heal. The location on the head could be due to a fall or other trauma, and the age of the patient increases the likelihood of poor circulation or other factors that impede healing.
- Other Likely Diagnoses
- Osteomyelitis of the skull: An infection of the bone that could be causing the wound to drain and not heal properly. The long duration of the wound and its drainage suggest a possible deep-seated infection.
- Squamous cell carcinoma or other skin cancers: These can present as non-healing wounds, especially in older adults. The location on the head, an area exposed to the sun, increases the risk of skin cancer.
- Actinomycosis: A rare bacterial infection that can cause chronic, draining wounds, although it's less common than other diagnoses.
- Do Not Miss Diagnoses
- Cranial osteomyelitis with intracranial complications: While less likely, if the infection has spread to the bone of the skull, it could lead to serious intracranial complications such as abscesses or meningitis, which are life-threatening.
- Malignancy (e.g., basal cell carcinoma, melanoma): Although less likely than squamous cell carcinoma, other skin malignancies could present similarly and have a significant impact on prognosis if not diagnosed and treated promptly.
- Rare Diagnoses
- Mycetoma: A chronic, granulomatous infection of the skin and subcutaneous tissue that can cause draining sinuses, more common in tropical regions.
- Lymphoma or other systemic cancers metastasizing to the skin: While rare, certain systemic cancers can metastasize to the skin, presenting as non-healing wounds.
- Eosinophilic granuloma with skull involvement: Part of Langerhans cell histiocytosis, which can cause lytic bone lesions and potentially lead to soft tissue wounds.
Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially, further diagnostic testing such as biopsies, imaging studies, or cultures to determine the underlying cause of the wound.