Differential Diagnosis for a 3-year-old boy with nasal discharge
- Single most likely diagnosis
- E. Nasal foreign body: The patient's symptoms of unilateral purulent nasal discharge, which has become progressively thicker and more malodorous over time, without systemic symptoms such as fever, are highly suggestive of a nasal foreign body. The absence of symptoms on the left side and the normal appearance of the left nasal mucosa further support this diagnosis.
- Other Likely diagnoses
- A. Acute bacterial sinusitis: Although less likely given the unilateral presentation and lack of systemic symptoms, acute bacterial sinusitis could still be a consideration, especially if the patient had a recent viral upper respiratory infection.
- C. Allergic rhinosinusitis: This could be a possibility, especially with the presence of a pet dog, but the unilateral nature of the symptoms and the lack of other allergic symptoms (such as itching, sneezing, or conjunctivitis) make it less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Mucormycosis: Although rare, mucormycosis is a serious and potentially life-threatening infection that can occur in immunocompromised patients, such as those with HIV. The patient's history of congenitally acquired HIV and antiretroviral therapy, along with the presence of unilateral nasal symptoms, necessitates consideration of this diagnosis.
- Rare diagnoses
- B. Adenoid hypertrophy: While adenoid hypertrophy can cause nasal obstruction and discharge, it typically presents with bilateral symptoms and is often associated with other symptoms such as mouth breathing, snoring, or recurrent otitis media. This diagnosis is less likely given the unilateral nature of the patient's symptoms.