[41F] With painful scalp boils, sore throat, eye drainage, and respiratory symptoms

Patient Description

A 41-year-old female presents with painful boils on her scalp, a sore throat, greenish and crusty eye drainage that mats her eyes closed in the morning, fatigue, cough, and runny nose. The eye drainage has been present for about a week, with approximately a teaspoon of discharge daily. The patient reports a constant throbbing pain in the scalp, which becomes severely sharp and shooting when touched or brushed. The boils on the scalp are pus-filled. She also experiences seeing things move in her peripheral vision that aren't there and sometimes has difficulty focusing. These visual disturbances are new and have not been experienced before. Additionally, the patient reports shortness of breath, fever, chills, nausea, and vomiting. She has a history of tobacco use (one pack per day for 30 years) and daily methamphetamine use. Her medical history includes vitamin deficiency, congestive heart failure (CHF), and rapid weight loss. She is unsure about her vaccination status and any recent exposure to infections.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Painful Boils on Scalp

  • Folliculitis or Abscesses: These are infections of the hair follicles or deeper skin layers, often caused by bacteria. They can be painful and filled with pus.
  • Treatment: Warm compresses can help drain the boils. Antibiotics may be needed if the infection is severe.

Sore Throat, Cough, Runny Nose, and Fatigue

  • Upper Respiratory Infection (URI): This could be a viral or bacterial infection affecting your throat and respiratory tract.
  • Treatment: Rest, hydration, and over-the-counter medications like acetaminophen or ibuprofen can help alleviate symptoms. If bacterial, antibiotics may be prescribed.

Eye Drainage

  • Conjunctivitis (Pink Eye): The greenish, crusty drainage suggests a bacterial infection.
  • Treatment: Antibiotic eye drops or ointments are typically used to treat bacterial conjunctivitis.

Vision Changes

  • Possible Neurological or Ophthalmological Issue: Seeing things in your peripheral vision that aren't there and difficulty focusing could be related to a neurological issue or an eye condition.
  • Treatment: This requires immediate medical attention for proper diagnosis and treatment.

Shortness of Breath, Fever, and Chills

  • Possible Severe Infection or Heart Failure Exacerbation: Given your history of congestive heart failure (CHF), these symptoms could indicate a worsening of your condition or a severe infection.
  • Treatment: Immediate medical evaluation is necessary to determine the cause and appropriate treatment.

What you can do

Painful Boils on Scalp

  • Warm Compresses: Apply warm compresses to the affected area to help drain the boils.
  • Avoid Picking: Do not pick or squeeze the boils to prevent further infection.
  • Seek Medical Attention: Consult a healthcare provider for possible antibiotic treatment.

Sore Throat, Cough, Runny Nose, and Fatigue

  • Rest and Hydration: Ensure you get plenty of rest and stay hydrated.
  • Over-the-Counter Medications: Use medications like acetaminophen or ibuprofen to manage pain and fever.
  • Seek Medical Attention: If symptoms persist or worsen, consult a healthcare provider.

Eye Drainage

  • Warm Compresses: Apply warm compresses to your eyes to help with drainage.
  • Avoid Touching Eyes: Do not touch or rub your eyes to prevent spreading the infection.
  • Seek Medical Attention: You may need antibiotic eye drops or ointments.

Vision Changes

  • Immediate Medical Attention: Given the changes in your vision, it's crucial to seek immediate medical attention to rule out serious conditions.

Shortness of Breath, Fever, and Chills

  • Immediate Medical Attention: These symptoms could indicate a severe infection or worsening of your CHF. Seek immediate medical care.

What you should look out for

Given the severity and combination of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Worsening Shortness of Breath: This could indicate a serious issue with your heart or lungs.
  • High Fever or Severe Chills: These could be signs of a severe infection.
  • Severe Pain or Rapid Spread of Boils: This could indicate a spreading infection.
  • Vision Changes: Any worsening of your vision or new symptoms should be evaluated immediately.

Remember, while I can provide some guidance, it's essential to consult with a healthcare provider for a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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5 mo ago


People Also Ask


What causes painful boils on the scalp and how can they be treated?

Painful boils on the scalp are often caused by infections of the hair follicles, known as folliculitis, or deeper skin infections called abscesses. They can be treated with warm compresses to help drain the boils and, if necessary, antibiotics prescribed by a healthcare provider.


What are the common symptoms and treatments for conjunctivitis?

Conjunctivitis, or pink eye, is characterized by symptoms such as eye redness, greenish or crusty discharge, and matting of the eyes. Bacterial conjunctivitis is typically treated with antibiotic eye drops or ointments.


What could be the reason for seeing things in peripheral vision that aren't there?

Seeing things in peripheral vision that aren't there could be related to neurological issues or eye conditions. It is important to seek immediate medical attention to determine the underlying cause and receive appropriate treatment.


How does a history of congestive heart failure affect symptoms like shortness of breath and fever?

A history of congestive heart failure can exacerbate symptoms like shortness of breath and fever, potentially indicating a worsening of the heart condition or a severe infection. Immediate medical evaluation is necessary to address these symptoms appropriately.

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