Differential Diagnosis for 63-year-old Male with Pus Oozing from Toenail
- Single most likely diagnosis:
- Paronychia: This is an infection of the skin around the nail, which can cause pus to ooze from the toenail. It's a common condition, especially in older adults, and can be caused by bacterial or fungal infections.
- Other Likely diagnoses:
- Onychomycosis (fungal infection of the nail): This can lead to nail thickening, discoloration, and sometimes pus formation, especially if a bacterial infection is superimposed.
- Ingrown toenail: This condition can cause redness, swelling, and sometimes pus, especially if the nail grows into the surrounding skin and causes an infection.
- Cellulitis: A bacterial skin infection that can cause redness, swelling, and pus, especially if it involves the skin around the toenail.
- Do Not Miss diagnoses:
- Osteomyelitis (bone infection): Although less common, an infection of the bone underlying the toenail can cause pus to ooze from the nail and is a serious condition that requires prompt treatment.
- Diabetic foot infection: In patients with diabetes, even a minor infection like paronychia can quickly become severe and lead to serious complications, including amputation.
- Septic arthritis: If the infection spreads to the joint, it can cause septic arthritis, a serious condition that requires immediate medical attention.
- Rare diagnoses:
- Squamous cell carcinoma: A type of skin cancer that can cause ulceration and pus formation, although it's less common in the toenail area.
- Melanonychia: A condition where melanin accumulates in the nail, causing discoloration, and can sometimes be mistaken for an infection.
- Psoriatic nail dystrophy: A condition associated with psoriasis that can cause nail thickening, pitting, and sometimes pus formation.