Differential Diagnosis for Swelling of Coronal Sulcus
Single most likely diagnosis
- Phimosis or paraphimosis: Although the patient is circumcised, it's possible that there's a residual or acquired condition affecting the foreskin, causing swelling around the glans. However, given the circumcision status, this might be less likely but still considered due to the swelling location and previous episode.
- More likely: Balanitis: An inflammation of the glans penis, which could cause swelling around the coronal sulcus and is consistent with the patient's symptoms, including groin tenderness due to potential lymphadenopathy.
Other Likely diagnoses
- Contact dermatitis: An allergic reaction or irritation from soaps, condoms, or other products could cause swelling and tenderness in the genital area.
- Sexually transmitted infections (STIs): Conditions like gonorrhea, chlamydia, or syphilis could present with genital swelling, discharge, and groin tenderness.
- Urethritis: Inflammation of the urethra, which could be due to infection or other causes, leading to symptoms including swelling around the glans and groin pain.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Testicular torsion: Although the primary symptom is usually acute testicular pain, any condition causing significant groin pain and swelling should prompt consideration of this emergency.
- Fournier's gangrene: A severe and potentially life-threatening condition involving necrotizing fasciitis of the genital area, which could present with swelling, pain, and systemic symptoms.
- Epididymitis: Inflammation of the epididymis, usually caused by bacterial infection, which can present with testicular pain and swelling, and could potentially lead to more severe complications if not treated.
Rare diagnoses
- Fixed drug eruption: A rare condition where certain medications cause skin lesions, including on the genitals, which could potentially mimic the symptoms described.
- Genital herpes: While not rare, it's less likely given the description focused on swelling around the coronal sulcus without mention of vesicles or ulcers, but it should still be considered in the differential for genital symptoms.
- Squamous cell carcinoma or other genital cancers: Extremely rare and unlikely in the absence of other symptoms like a mass or ulcer, but any persistent or unexplained genital symptom warrants consideration of malignancy.