Differential Diagnosis for a 6-year-old boy with nasal discharge, congestion, and cough
- Single most likely diagnosis:
- Acute bacterial sinusitis: The patient's symptoms of thick and persistent nasal discharge, nasal congestion, and cough, along with the physical examination findings of yellow mucus in the posterior nasopharynx, red and swollen nasal turbinates, and tender maxillary sinuses, are consistent with acute bacterial sinusitis. The duration of symptoms (10 days) also supports this diagnosis, as viral upper respiratory infections typically resolve within 7-10 days.
- Other Likely diagnoses:
- Viral upper respiratory infection: Although the duration of symptoms is longer than typical for a viral infection, it is still possible that the patient has a prolonged viral upper respiratory infection.
- Allergic rhinitis: The patient's history of asthma and the presence of red and swollen nasal turbinates suggest the possibility of allergic rhinitis, which could be contributing to the patient's symptoms.
- Viral sinusitis: The patient's symptoms could also be consistent with viral sinusitis, which is often difficult to distinguish from acute bacterial sinusitis without further testing.
- Do Not Miss diagnoses:
- Orbital cellulitis: Although the patient does not have any symptoms such as eye pain, swelling, or proptosis, orbital cellulitis is a potentially serious complication of sinusitis that requires prompt recognition and treatment.
- Intracranial complications of sinusitis: Rarely, sinusitis can lead to intracranial complications such as meningitis, brain abscess, or subdural empyema, which are medical emergencies.
- Rare diagnoses:
- Cystic fibrosis: Although the patient has a history of mild asthma, the presence of persistent nasal discharge and sinusitis could raise the possibility of cystic fibrosis, particularly if the patient has other symptoms such as recurrent respiratory infections or gastrointestinal symptoms.
- Primary ciliary dyskinesia: This rare genetic disorder is characterized by chronic respiratory infections, including sinusitis, and could be considered in a patient with recurrent or persistent sinusitis.
- Immunodeficiency: A patient with recurrent or severe infections, including sinusitis, may have an underlying immunodeficiency, which would require further evaluation and testing.