Differential Diagnosis
The patient's symptoms of redness and foreign body sensation in both eyes, violent coughing spells followed by a high-pitched inspiratory sound, low-grade fevers, and runny nose can be attributed to various conditions. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Pertussis (whooping cough) with associated conjunctivitis: The patient's symptoms of violent coughing spells followed by a high-pitched inspiratory sound, low-grade fevers, and runny nose are classic for pertussis, especially given her incomplete vaccination status. The conjunctival hemorrhage and petechiae can be associated with the intense coughing spells.
Other Likely diagnoses
- Adenoviral conjunctivitis: The patient's symptoms of redness and foreign body sensation in both eyes, along with conjunctival hemorrhage, could be indicative of adenoviral conjunctivitis, which is highly contagious and often accompanied by upper respiratory symptoms.
- Allergic conjunctivitis: Although less likely given the acute onset and systemic symptoms, allergic conjunctivitis could be considered, especially if the patient has a history of allergies.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Epiglottitis: Although the patient's oropharyngeal examination shows no abnormalities, epiglottitis is a life-threatening condition that requires prompt recognition and treatment. The patient's symptoms of violent coughing and high-pitched inspiratory sound could be indicative of airway obstruction.
- Bacterial conjunctivitis (e.g., Neisseria gonorrhoeae): This condition can cause severe conjunctivitis and is a concern in unvaccinated or immunocompromised patients.
Rare diagnoses
- Kawasaki disease: This condition is characterized by fever, conjunctivitis, and cough, but it typically presents with additional symptoms such as rash, lymphadenopathy, and changes in the extremities.
- Stevens-Johnson syndrome: This rare condition is characterized by conjunctivitis, skin lesions, and mucosal involvement, but it is often associated with medication use or infections such as Mycoplasma pneumoniae.