Differential Diagnosis
- Single most likely diagnosis
- Hyper-IgE syndrome (Job syndrome): This condition is characterized by recurrent cutaneous and pulmonary infections, particularly with Staphylococcus aureus, and elevated IgE levels. The patient's history of recurrent skin abscesses, atopic dermatitis, and eosinophilia (40% eosinophils) supports this diagnosis.
- Other Likely diagnoses
- Atopic dermatitis with secondary infection: The patient's history of atopic dermatitis and recurrent skin infections is consistent with this diagnosis. The presence of dry lichenified plaques, excoriations, and a skin abscess supports this diagnosis.
- Allergic contact dermatitis: This condition could be contributing to the patient's skin symptoms, particularly the dry lichenified plaques and excoriations.
- Immunodeficiency (e.g., chronic granulomatous disease): The patient's recurrent infections and eosinophilia could suggest an underlying immunodeficiency.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cellulitis or necrotizing fasciitis: Although the patient's abscess is not tender, it is essential to consider the possibility of a more severe infection, such as cellulitis or necrotizing fasciitis, which could be life-threatening if not promptly treated.
- Sepsis: Although the patient's vital signs are stable, it is crucial to consider the possibility of sepsis, particularly if the abscess is not adequately drained or if the patient has an underlying immunodeficiency.
- Rare diagnoses
- Wiskott-Aldrich syndrome: This rare X-linked recessive disorder is characterized by eczema, thrombocytopenia, and recurrent infections. Although the patient's platelet count is normal, this diagnosis could be considered if other symptoms are present.
- IPEX syndrome (Immune dysregulation, Polyendocrinopathy, Enteropathy, X-linked syndrome): This rare condition is characterized by autoimmune enteropathy, eczema, and recurrent infections. Although the patient's symptoms do not entirely fit this diagnosis, it could be considered if other symptoms are present.