System PE ID findings Noninfectious mimics Diagnostic features
- Amebic colitis
- Tuberculous
colitis - Actinomycosis
- Mycobacterium
avium-intracellulare
(in AIDS) - Angiostrongylus
costaricensis - Balantidium coli
- Ascariasis
l Ectopic pregnancy
l Cecal adenocarcinoma
l Carcinoid
Obturator sign 1. Appendicitis
- Pelvic abscess
l Pelvic fracture
l Obturator muscle spasm/
dysfunction
Fever and leukocytosis in
appendicitis/pelvic abscess.
Psoas sign 1. Appendicitis
- Psoas abscess
l Psoas hematoma
l Iliopsoas bursitis
Fever and leukocytosis in
appendicitis/psoas abscess.
CT scanning in psoas
hematoma.
Tender
hepatomegaly
- Acute viral
hepatitis - Hepatic abscess
(pyogenic, amebic,
Toxoplasma) - Typhoid
- Disseminated
candidiasis - Echinococcosis
- Acute
schistosomiasis - Fascioliasis
- Clonorchiasis
- Hepatic capillariasis
l Acute alcoholic hepatitis
l Drug-induced hepatitis
l Right-sided heart failure/
constrictive pericarditis
l Hepatic sickle cell crisis
l Budd–Chiari syndrome
Clinical context. There may be
a friction rub over a hepatic
abscess. Serology,
ultrasonography, culture to
distinguish the various
etiologies.
Splenomegaly 1. Acute infections
(e.g., EBV, CMV,
hepatitis, SBE,
psittacosis, cat
scratch disease)
- Chronic infections
(e.g., miliary TB,
malaria,
schistosomiasis,
AIDS brucellosis,
visceral
leishmaniasis,
syphilis,
toxoplasmosis)
Congestive—cirrhosis, portal
hypertension, CHF, compression
or thrombosisof portal or splenic
vein
l Neoplasms—lymphoproliferative
disorders, myeloproliferative
disorders
l Inflammatory—sarcoidosis,
amyloidosis
l Connective tissue diseases—
SLE, RA
l Hemolytic anemias
l Storage diseases (e.g.,
Gaucher’s, Niemann–Pick,
etc.)
Based on the clinical context,
blood and other appropriate
cultures, serological testing,
review of peripheral smear
and, rarely, splenic biopsy.
Prostatic nodule 1. Tuberculosis l Cancer
l Leiomyoma
In TB, the seminal vesicle and
vas deferens are also
involved.
Carpo-metacarpal
ulnar deviation
- Jaccoud’s arthritis
in recurrent
polyarthritis of
rheumatic fever
l Rheumatoid arthritis
l SLE
l Ulnar impaction syndrome
l Chronic hemiplegia
Initially, the deviation in
Jaccoud’s arthritis is
passively reducible. MCP
synovitis, swan neck, and
boutonniere deformities in
RA. Imaging.
(Continued)
Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care 59