Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Saddle nose
deformity

1. Syphilis l Relapsing polychondritis
   l Trauma, including post
   rhinoplasty
   l Wegener’s granulomatosis
   l Leprosy

Distinguished based on history,

serologic testing, and/or

biopsy

Intranasal eschar 1. Rhinocerebral
mucormycosis

2. Phaeo-
   hyphomycosis in
   allergic fungal
   sinusitis


3. Aspergillosis

l Wegner’s granulomatosis

l Cocaine abuse

Culture first, then biopsy and/or

serologic testing if necessary

Nasal septal
perforation

1. Syphilis


2. Tuberculosis

l Cocaine/oxymetazoline abuse

l Wegener’s granulomatosis

l Midline granuloma

l SLE

l Mixed cryoglobulinemia

l Rheumatoid arthritis

l Mixed connective tissue disease

Culture/biopsy. Serologic

testing.

Swelling of the
cheek

1. Buccal space
   infection

l Angioedema Fever and tenderness in

infection

Tongue ulcer 1. Histoplasma
capsulatum

2. Herpes virus


3. CMV


4. Tuberculosis


5. Syphilis


6. Leishmania
   donovani


7. Blastomyces
   dermatitidis

l Oral lichen planus

l Behcet’s disease

l Wegener’s granulomatosis

l Amyloidosis

l Crohn’s disease

l Carcinoma

l TUGSE

Distinguished by culture,

serology and/or biopsy.

Wickham’s striae are seen in

lichen planus, macroglossia

in amyloidosis.

Palatal ulcer 1. Mucormycosis

2. Other fungal
   infection (i.e.,
   phaeo-
   hyphomycosis)


3. Histoplasmosis


4. Syphilis

l Drug induced (esp.

methotrexate)

l Cancer/lymphoma

l Wegener’s granulomatosis

l Crohn’s disease

l Midline granuloma

l Major aphthous ulcer

l Sweet’s syndrome

Distinguished by culture,

serology (if necessary) and/

or biopsy

Palatal purpura 1. Early Kaposi
sarcoma

l Trauma

l Coagulopathy

KS will progress over time

whereas true purpura will

resolve.

Tonsillar
inflammation/
enlargement

1. Tonsillar abscess


2. Syphilis

l Cancer

l Amyloidosis

l Lymphoma

l Sarcoidosis

Culture and/or biopsy

Gingival edema,
inflammation,
ulceration

1. Acute necrotizing
   ulcerative gingivitis
   (Vincent’s angina)


2. Herpangina

l Leukemic gingivitis

l Scurvy

l Agranulocytosis

l Cyclic neutropenia

l Acatalasia

Leukopenia suggests

agranulocytosis or cyclic

neutropenia. Follicular

hyperkeratosis, purpura, and

corkscrew hairs are seen in

scurvy. Premature WBC

forms on peripheral smear in

leukemia.

(Continued)

Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care 53