Differential Diagnosis for Recurrent Necrotic Lesions in a Child with Fever
Single Most Likely Diagnosis
- Ecthyma Gangrenosum: This condition is characterized by recurrent necrotic lesions and is often associated with Pseudomonas aeruginosa bacteremia, particularly in immunocompromised children. The presence of fever and necrotic lesions makes this a strong consideration.
Other Likely Diagnoses
- Staphylococcal Scalded Skin Syndrome (SSSS): Caused by staphylococcal toxins, SSSS can present with fever and skin lesions that can progress to necrosis, especially in young children.
- Fungal Infections (e.g., Candidiasis): In immunocompromised children, fungal infections can cause recurrent skin lesions, including necrotic ones, accompanied by fever.
- Bacterial Infections (e.g., Streptococcal or Staphylococcal): Various bacterial infections can cause skin lesions and fever, including necrotizing fasciitis, which, although rare in children, can be severe.
Do Not Miss Diagnoses
- Meningococcemia: Although less common, meningococcemia can present with fever and skin lesions (petechiae or purpura) that can evolve into necrotic lesions. It's critical to consider this diagnosis due to its high mortality rate if not promptly treated.
- Disseminated Gonococcal Infection: In sexually active adolescents, this infection can cause fever, skin lesions, and arthritis. It's a critical diagnosis to consider due to its implications and the need for prompt treatment.
- Kawasaki Disease: An acute febrile illness that can cause skin lesions, among other symptoms. Although not typically necrotic, the disease's potential to cause coronary artery aneurysms makes it a critical diagnosis not to miss.
Rare Diagnoses
- Leukocyte Adhesion Deficiency (LAD): A rare immunodeficiency characterized by recurrent infections and impaired wound healing, which can lead to necrotic lesions.
- Chronic Granulomatous Disease (CGD): Another rare immunodeficiency that can lead to recurrent infections, including those of the skin, which may present as necrotic lesions.
- Ehlers-Danlos Syndrome: A group of disorders that can affect the skin, leading to poor wound healing and potentially necrotic lesions, although this is less commonly associated with fever.