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 due to their tendency to cause recurrent and severe skin infections, this diagnosis is highly plausible. MRSA infections can occur in any part of the body and are known for their difficulty in treatment due to antibiotic resistance.

• Other Likely Diagnoses

  • Folliculitis: This condition involves inflammation of the hair follicles and can present with boil-like lesions. It can be caused by bacterial infections, including Staphylococcus aureus, and could be a consideration given the patient's symptoms.
  • Furunculosis: Similar to folliculitis but involving a deeper infection of the hair follicle, leading to the formation of a furuncle or boil. This could be a possible diagnosis given the description of the patient's symptoms.
  • Hygiene-related Skin Infections: Poor hygiene can lead to bacterial infections of the skin, which might present similarly to the patient's condition. However, the specific locations and the patient's history of MRSA make this less likely.

• Do Not Miss Diagnoses

  • Necrotizing Fasciitis: Although less common, this is a severe infection that can start with symptoms similar to boils but rapidly progresses to necrosis of the fascia and underlying tissues. It is critical to consider this diagnosis due to its high mortality rate if not promptly treated.
  • Cellulitis: An infection of the skin and subcutaneous tissues that can spread rapidly. While it typically presents with redness, swelling, and warmth of the skin, it could be considered, especially if the patient's condition worsens or does not respond to initial treatment.

• Rare Diagnoses

  • Hidradenitis Suppurativa: A chronic skin condition characterized by recurrent, painful abscesses and nodules in the apocrine-gland-bearing areas of the body, such as the groin and buttocks. Although it could be a consideration given the locations of the boils, the patient's history of MRSA and the acute presentation make this less likely.
  • Erythema Induratum: A type of panniculitis that can present with recurrent, painful nodules on the legs but can occasionally occur in other areas. It is less common and typically associated with tuberculosis, making it a rare consideration in this context.