Differential Diagnosis for Multiple Boils on Labial Majora and Buttock

The patient presents with multiple boils on her right labial majora and one on her right buttock, with a history of MRSA. Considering the history and presentation, the differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis

  • MRSA Infection: Given the patient's history of MRSA and the presence of boils, which are characteristic of MRSA skin infections, this is the most likely diagnosis. MRSA is known for causing skin and soft tissue infections, including boils (furuncles) and abscesses.

• Other Likely Diagnoses

  • Folliculitis: This is an inflammation of the hair follicles, which can be caused by bacterial infection, including MRSA. It presents with small, pus-filled bumps and could be a precursor to more severe infections like boils.
  • Furuncles or Carbuncles: These are more severe forms of folliculitis and can occur when the infection spreads deeper into the skin, forming a larger, more painful nodule or cluster of nodules.
  • Hygiene-related Skin Infections: Poor hygiene can lead to bacterial infections, including those caused by Staphylococcus aureus (not necessarily MRSA), which can manifest as boils or other skin lesions.

• Do Not Miss Diagnoses

  • Necrotizing Fasciitis: Although rare, this is a life-threatening condition that requires immediate medical attention. It's an infection that destroys the tissue under the skin, including fat and the tissue covering the muscles (fascia). Early signs can be similar to those of a severe skin infection, making it crucial not to miss.
  • Cellulitis: A bacterial skin infection that can spread rapidly and become severe. It requires prompt antibiotic treatment, especially if MRSA is suspected.

• Rare Diagnoses

  • Hidradenitis Suppurativa (HS): A chronic skin condition characterized by recurring, painful abscesses and nodules in the apocrine-gland-bearing areas of the body, such as the groin and underarms. While it could explain the boils, the direct connection to MRSA history makes it less likely in this context.
  • Erythrasma: A superficial fungal or bacterial infection affecting the intertriginous areas, which could potentially cause lesions that might resemble boils, though it's less common in the described locations and typically doesn't have the same severity as MRSA infections.

Each diagnosis is considered based on the patient's symptoms and history, with an emphasis on the most likely cause given the MRSA history. However, it's crucial to consider all possibilities to ensure appropriate treatment and to avoid missing potentially life-threatening conditions.