What is the diagnosis for a 5-year-old patient with acute respiratory distress, characterized by difficulty breathing for 2 hours, fever, and cough for 4 days, with a history of Gastroesophageal Reflux Disease (GERD) as an infant, presenting with worsening stridor, agitation, and thick yellow nasal and oropharyngeal discharge?

Differential Diagnosis for a 5-year-old with Difficulty Breathing

• Single most likely diagnosis:
  • Croup: The presence of stridor, worsening with agitation, and a history of fever and cough, points towards croup as the most likely diagnosis. The thick yellow discharge in the nasal mucosa and oropharynx further supports this, as croup often presents with such symptoms.
• Other Likely diagnoses:
  • Acute Bronchiolitis: Given the age of the patient and the symptoms of difficulty breathing, fever, and cough, acute bronchiolitis is a plausible diagnosis, especially if the patient has been exposed to respiratory syncytial virus (RSV) or other viruses that commonly cause this condition.
  • Pneumonia: The combination of fever, cough, and difficulty breathing could also suggest pneumonia, particularly if the patient has a bacterial infection. The presence of thick yellow discharge supports this possibility.
  • Acute Epiglottitis: Although less common, acute epiglottitis should be considered, especially if the patient has a high fever, severe sore throat, and difficulty swallowing, in addition to respiratory distress.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Foreign Body Aspiration: This is a medical emergency that requires immediate attention. The sudden onset of difficulty breathing and stridor could be indicative of an obstructed airway due to a foreign body.
  • Anaphylaxis: Although the symptoms do not fully align with anaphylaxis, it's crucial to consider this diagnosis due to its potential for rapid progression to a life-threatening condition. Any signs of allergic reaction or exposure to known allergens should prompt consideration of anaphylaxis.
  • Bacterial Tracheitis: This condition can present similarly to croup but is caused by a bacterial infection and requires prompt antibiotic treatment. It's less common but can be severe.
• Rare diagnoses:
  • Angioedema: A rare condition that could cause airway obstruction and difficulty breathing, often associated with allergic reactions or genetic conditions.
  • Subglottic Stenosis: A rare condition, especially in children, that could cause stridor and difficulty breathing, often due to a congenital anomaly or acquired from prolonged intubation.