Differential Diagnosis
- Single most likely diagnosis
- Viral URI: Given the symptom constellation (nasal congestion, cough, rhinorrhea) and poor response to antibiotics, a viral upper respiratory infection is the most likely diagnosis. The presence of fever, decreased appetite, and vomiting also supports this diagnosis, as these symptoms are common in viral infections.
- Other Likely diagnoses
- Allergic rhinitis: The patient's history of eczema increases the likelihood of allergic rhinitis, which can present with similar symptoms to a viral URI, such as nasal congestion and rhinorrhea.
- Bacterial sinusitis: Although the patient did not respond to amoxicillin, bacterial sinusitis is still a possible diagnosis, especially given the persistent nature of the symptoms.
- Acute otitis media: This diagnosis is also possible, given the patient's age and symptoms such as cough and fever.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumonia: Although the patient's symptoms are more suggestive of a viral URI, pneumonia is a potentially life-threatening condition that must be ruled out, especially given the presence of fever and cough. The chest x-ray will help to evaluate for this condition.
- Bacterial sepsis: Although not directly mentioned, bacterial sepsis is a potentially life-threatening condition that can present with similar symptoms to a viral URI, such as fever and vomiting.
- Rare diagnoses
- Other rare viral or bacterial infections (e.g. influenza, pertussis): Although less likely, these infections can present with similar symptoms to a viral URI and should be considered if the patient's symptoms do not improve with supportive care.
- Immunodeficiency: Although very rare, an immunodeficiency could be considered if the patient has recurrent or persistent infections that do not respond to treatment. However, this would require further evaluation and testing.