Differential Diagnosis for Multiple Boils on Labial Majora and Buttock

The patient's presentation of multiple boils on her right labial majora and one on her right buttock, coupled with a history of MRSA, suggests several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • MRSA Infection: Given the patient's history of MRSA and the presence of multiple boils, which are characteristic of MRSA 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 Staphylococcus aureus (not necessarily MRSA). The symptoms can include boils or pustules, especially in areas with high hair density like the buttocks and pubic area.
  • Furunculosis: This condition is characterized by the recurring formation of boils (furuncles), often due to Staphylococcus aureus infection. The patient's history of boils on the labial majora and buttock could suggest a tendency towards furunculosis.
  • Hygiene-related Skin Infections: Poor hygiene can lead to bacterial infections of the skin, manifesting as boils or abscesses, particularly in areas prone to moisture and friction like the buttocks and genital area.

• Do Not Miss Diagnoses

  • Necrotizing Fasciitis: Although less common, this is a severe infection of the skin and subcutaneous tissues that can start with symptoms similar to those of a boil or abscess but rapidly progresses. It is critical to identify early due to its high mortality rate if not promptly treated.
  • Cellulitis: An infection of the skin and subcutaneous tissues, which can be caused by bacteria. While it typically presents with redness, swelling, and warmth of the skin, in some cases, it can start with or include boils.
  • Ecthyma: A variant of impetigo that extends into the dermis, causing shallow ulcerations. It's less likely but could be considered, especially if there are ulcerative lesions.

• Rare Diagnoses

  • Hidradenitis Suppurativa (HS): A chronic skin condition characterized by recurrent, painful abscesses and nodules in apocrine-gland-bearing areas, such as the groin and buttocks. While it could be considered, the presence of MRSA history and the specific locations might make it less likely.
  • Kerion: A severe form of tinea capitis (fungal infection of the scalp) that can cause boils or abscess-like lesions, but it's highly unlikely given the locations described.
  • Cutaneous Crohn’s Disease: A rare manifestation of Crohn’s disease that can cause skin lesions, including abscesses and fistulas, particularly in the perianal and genital areas. This would be an unusual presentation and is less likely without a known history of Crohn’s disease.