Differential Diagnosis for Persistent Nasal Congestion in a 9-year-old Girl
- Single most likely diagnosis:
- Acute bacterial sinusitis: This is the most likely diagnosis given the patient's symptoms of persistent nasal congestion, purulent nasal drainage, and mucopurulent discharge in the posterior pharynx, which have not improved despite treatment with over-the-counter medications. The presence of erythema and swelling of the nasal turbinates further supports this diagnosis.
- Other Likely diagnoses:
- Allergic rhinitis: The patient's symptoms of nasal congestion, rhinorrhea, and cough could be indicative of allergic rhinitis, especially given the chronic nature of the symptoms and the fact that the patient has had to miss swim practice.
- Viral upper respiratory infection: Although the fever has resolved, the patient's symptoms could still be consistent with a viral upper respiratory infection, which may take longer to resolve.
- Environmental exposure (e.g., secondhand smoke): The patient's father smokes cigarettes outside the house, which could be contributing to the patient's respiratory symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Intracranial complications of sinusitis (e.g., abscess, meningitis): Although rare, these complications can be life-threatening and require prompt diagnosis and treatment.
- Nasal foreign body: A nasal foreign body could cause persistent nasal congestion and discharge, and would require urgent removal to prevent further complications.
- Rare diagnoses:
- Cystic fibrosis: This genetic disorder can cause chronic respiratory symptoms, including nasal congestion and cough, although it would be unusual for it to present for the first time at this age.
- Immunodeficiency: A primary immunodeficiency could predispose the patient to recurrent or persistent infections, including sinusitis.
- Nasal tumor (e.g., juvenile nasopharyngeal angiofibroma): Although rare, a nasal tumor could cause persistent nasal congestion and discharge, and would require prompt diagnosis and treatment.