Differential Diagnosis for 77-year-old Female Patient
Single Most Likely Diagnosis
- Acute Bacterial Sinusitis: The patient's symptoms of sinus pressure and congestion at the maxillary sinuses, worsening with leaning forward, green mucus production, and productive cough due to postnasal drip are classic for acute bacterial sinusitis. The presence of fever (97.9°F) and duration of symptoms (three weeks) also support this diagnosis.
Other Likely Diagnoses
- Viral Upper Respiratory Infection: Although the patient's symptoms have lasted for three weeks, which is longer than typical for a viral upper respiratory infection, it's still possible that the initial infection was viral and has now become secondary bacterial sinusitis.
- Allergic Rhinitis: The patient's symptoms of sinus pressure, congestion, and postnasal drip could also be due to allergic rhinitis, especially if she has a history of allergies.
- Gastroenteritis: The patient's symptoms of nausea, vomiting, loose stool, and not having eaten in three days could be due to a separate gastrointestinal infection, such as gastroenteritis.
Do Not Miss Diagnoses
- Meningitis: Although less likely, the patient's symptoms of headache (implied by sinus pressure) and fever could be indicative of meningitis, which is a medical emergency. The presence of nausea and vomiting also increases the concern for meningitis.
- Severe Dehydration: The patient's symptoms of nausea, vomiting, and not having eaten in three days put her at risk for severe dehydration, which can lead to electrolyte imbalances and other complications.
- Pneumonia: The patient's productive cough and low oxygen saturation (92% on room air) could be indicative of pneumonia, especially if the postnasal drip is aspirated.
Rare Diagnoses
- Wegener's Granulomatosis: A rare autoimmune disorder that can cause sinusitis, but would typically be accompanied by other systemic symptoms such as kidney disease or skin lesions.
- Fungal Sinusitis: A rare infection that can cause sinusitis, but would typically be seen in immunocompromised patients or those with a history of fungal exposure.
- Tumor or Mass: A rare cause of sinus pressure and congestion, but would typically be accompanied by other symptoms such as facial pain, vision changes, or nasal obstruction.