Differential Diagnosis for a 5-month-old with RSV and Glucose 127
- Single most likely diagnosis: + Bronchiolitis: This is the most likely diagnosis given the patient's age and positive RSV test. RSV is a common cause of bronchiolitis in infants, and the presentation is consistent with this diagnosis.
- Other Likely diagnoses: + Viral pneumonia: Although RSV is more commonly associated with bronchiolitis, it can also cause pneumonia, especially in young infants. The elevated glucose could be a stress response to the infection. + Asthma exacerbation: Although less likely in a 5-month-old without a prior diagnosis of asthma, an asthma exacerbation could present with similar symptoms to bronchiolitis, especially if the child has a history of wheezing or eczema.
- Do Not Miss diagnoses: + Bacterial pneumonia or sepsis: Although the RSV test is positive, bacterial superinfection or concurrent bacterial pneumonia is possible and can be life-threatening. The elevated glucose could be a sign of stress or sepsis. + Congenital heart disease: Infants with underlying congenital heart disease may present with respiratory symptoms due to increased pulmonary blood flow or congestion. Although less likely, this diagnosis could be deadly if missed.
- Rare diagnoses: + Inborn errors of metabolism: Certain metabolic disorders, such as glycogen storage diseases, can present with elevated glucose levels and respiratory symptoms. However, these diagnoses are rare and would require further testing to confirm. + Other viral infections: Although RSV is the most common cause of bronchiolitis, other viruses such as influenza, adenovirus, or human metapneumovirus could also be responsible for the patient's symptoms.