Differential Diagnosis for a 22-month-old with Nasal Congestion, Cough, and Rhinorrhea
- Single Most Likely Diagnosis
- Viral upper respiratory infection (URI): The child's symptoms of nasal congestion, cough, and rhinorrhea, along with the recent exposure to strep and the lack of resolution with antibiotic treatment, suggest a viral etiology. The presence of fever, decreased appetite, and vomiting also supports this diagnosis.
- Other Likely Diagnoses
- Bacterial sinusitis: The child's history of sinus infection and the description of the nasal drainage as thick yellowish-green suggest a possible bacterial infection. However, the lack of response to amoxicillin and the presence of viral symptoms make this less likely.
- Allergic rhinitis: The child's history of eczema and evaluation by an allergist suggest a possible allergic component to the symptoms. However, the recent onset of fever and vomiting makes this less likely as the primary diagnosis.
- Acute otitis media: The child's symptoms of cough and rhinorrhea, along with the evaluation by an ENT, suggest a possible ear infection. However, the lack of specific ear symptoms makes this less likely.
- Do Not Miss Diagnoses
- Bacterial pneumonia: The child's symptoms of fever, cough, and vomiting, along with the chest x-ray, require consideration of a possible bacterial pneumonia. Although the lung sounds are reported as congested, a chest x-ray is essential to rule out pneumonia.
- Influenza: The child's symptoms of fever, cough, and vomiting, along with the recent exposure to strep, require consideration of a possible influenza infection. Although the viral panel may help diagnose this, a high index of suspicion is necessary.
- Epiglottitis: Although rare, epiglottitis is a life-threatening condition that requires prompt diagnosis and treatment. The child's symptoms of fever, cough, and vomiting, along with the history of recent exposure to strep, make this a "do not miss" diagnosis.
- Rare Diagnoses
- Cystic fibrosis: The child's recurrent respiratory symptoms and lack of response to treatment may suggest a possible underlying condition such as cystic fibrosis. However, this is a rare diagnosis and would require further evaluation and testing.
- Immunodeficiency: The child's recurrent infections and lack of response to treatment may suggest a possible immunodeficiency. However, this is a rare diagnosis and would require further evaluation and testing.
- Foreign body aspiration: The child's symptoms of cough and vomiting may suggest a possible foreign body aspiration. However, this is a rare diagnosis and would require further evaluation and testing.