Differential Diagnosis for a 15-year-old Male with Sinus Congestion, Vomiting, and Headache
- Single most likely diagnosis:
- Viral upper respiratory infection (e.g., common cold or influenza): This is the most likely diagnosis given the initial presentation of sinus congestion for 2 weeks, which is a typical duration for a viral upper respiratory infection. The addition of vomiting and headache could be due to a secondary viral gastroenteritis or a complication like sinusitis.
- Other Likely diagnoses:
- Sinusitis: Given the 2 weeks of sinus congestion, bacterial sinusitis is a possible complication, especially if the symptoms have worsened or if there are signs of infection such as facial pain or purulent nasal discharge.
- Viral gastroenteritis: This could explain the vomiting and is consistent with a viral infection, possibly unrelated to the sinus congestion.
- Migraine or tension headache: These conditions could cause headache and vomiting, especially if the patient has a history of migraines.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Meningitis: Although less likely, meningitis is a critical diagnosis that must be considered, especially with the symptoms of headache and vomiting. It requires immediate medical attention.
- Encephalitis: Similar to meningitis, encephalitis is an inflammation of the brain that could present with headache, vomiting, and altered mental status, and is a medical emergency.
- Brain abscess or intracranial complication of sinusitis: Although rare, these are potential complications of sinusitis that could present with headache and vomiting, and are life-threatening.
- Rare diagnoses:
- Temporal arteritis: This condition is rare in teenagers but could cause headache and is associated with other systemic symptoms.
- Brain tumor: Although extremely rare and unlikely to present acutely, a brain tumor could cause increased intracranial pressure leading to headache and vomiting.
- Acute disseminated encephalomyelitis (ADEM): A rare autoimmune disease that could follow a viral infection, presenting with neurological symptoms including headache and vomiting.