Differential Diagnosis for a 10-year-old with Foot Swelling after a Burn
Single most likely diagnosis
- Burn wound infection or cellulitis: This is the most likely diagnosis given the history of a burn, blister formation, and subsequent swelling. The lack of pain does not rule out infection, as some infections can present with minimal discomfort, especially in the early stages.
Other Likely diagnoses
- Contact dermatitis: An allergic reaction or irritation from the burn or its treatment could lead to swelling and blistering.
- Burn wound edema: Swelling is a common response to burns due to increased vascular permeability and can occur without infection.
- Superficial thrombophlebitis: Although less common, inflammation of the superficial veins could occur, especially if the burn was severe enough to cause significant tissue damage.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Gas gangrene: A rare but life-threatening condition caused by Clostridium perfringens infection, which can occur after a burn. It is characterized by rapid progression of swelling, pain, and crepitus (a grating sensation or sound from the fragments of a fractured bone).
- Necrotizing fasciitis: A severe infection that destroys tissue under the skin, including fat and the tissue covering the muscles (fascia). It's a medical emergency and can be fatal if not treated promptly.
- Sepsis: Although the child does not have pain, the possibility of sepsis, a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs, cannot be overlooked.
Rare diagnoses
- Erythema multiforme: A skin condition characterized by target lesions, which can be triggered by burns among other causes. It's less likely but could explain the swelling and blistering.
- Toxic epidermal necrolysis (TEN): A severe skin condition usually triggered by medications but can be caused by burns. It leads to widespread skin necrosis and detachment, which is a medical emergency.