Differential Diagnosis for 46-year-old Male with Thumb Pain and Infection
- Single most likely diagnosis:
- Osteomyelitis or Septic Arthritis: Given the history of a recent fracture and the presence of an odor, pus, and drainage from the nail bed, an infection of the bone (osteomyelitis) or the joint (septic arthritis) is highly likely. The proximity of the fracture to the nail bed and the mechanism of injury increase the risk of introducing bacteria into the wound.
- Other Likely diagnoses:
- Cellulitis: An infection of the skin and subcutaneous tissues, which could be a consequence of the trauma and fracture, especially if the wound was not properly cleaned and managed.
- Paronychia: An infection of the nail bed or the tissues surrounding the nail, which is consistent with the symptoms of pus draining from the nail bed.
- Abscess: A localized collection of pus that could have formed as a result of the infection, possibly requiring drainage.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Gas Gangrene: Although less common, gas gangrene (clostridial myonecrosis) is a potentially life-threatening condition that can occur after traumatic injuries, especially if the wound was contaminated with soil or other materials containing Clostridium species.
- Tetanus: Given the mechanism of injury (smashing the thumb during mechanic work), there's a risk of tetanus infection, especially if the patient's tetanus vaccination is not up to date.
- Rare diagnoses:
- Gout or Pseudogout: Although these conditions are more commonly associated with joint pain and swelling, a recent trauma could potentially trigger an acute attack in a predisposed individual.
- Eikenella corrodens Infection: This bacterium can cause infections after human bites or, less commonly, after other types of trauma, including crush injuries. It's known for its ability to cause infections in the hand.