Differential Diagnosis for 52-year-old Female with Sinus Congestion and Related Symptoms
- Single most likely diagnosis:
- Acute Bacterial Sinusitis: This is the most likely diagnosis given the patient's symptoms of sinus congestion, postnasal drainage, ear pressure, upper teeth pain, and decreased smell and taste, which have worsened despite over-the-counter medication. The initial fever and resolution of wheezing also support this diagnosis, as viral upper respiratory infections often precede bacterial sinusitis.
- Other Likely diagnoses:
- Chronic Sinusitis: The patient's symptoms have been present for a week and have worsened, which could indicate a chronic condition, especially if the patient has underlying anatomical issues or allergies.
- Allergic Rhinitis: The symptoms of sinus congestion, postnasal drainage, and decreased smell could be related to allergies, especially if the patient has a history of allergies or if the symptoms are seasonal.
- Viral Sinusitis: Although the patient tested negative for COVID-19, other viruses could cause similar symptoms, and the presence of fever and wheezing initially supports a viral etiology.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Cavernous Sinus Thrombosis: This is a rare but potentially life-threatening complication of sinusitis, characterized by the formation of a blood clot in the cavernous sinus. Symptoms can include headache, fever, and cranial nerve deficits.
- Orbital Cellulitis: An infection of the tissues surrounding the eye, which can be a complication of sinusitis. Symptoms include eye pain, swelling, and decreased vision.
- Meningitis: Although less common, meningitis can be a complication of sinusitis, especially if the infection spreads to the meninges. Symptoms include severe headache, fever, and stiff neck.
- Rare diagnoses:
- Sinus Tumors: Although rare, tumors in the sinuses can cause similar symptoms, including nasal congestion, postnasal drainage, and decreased smell.
- Fungal Sinusitis: This is a rare condition, usually affecting immunocompromised patients, characterized by fungal infection of the sinuses. Symptoms can include nasal congestion, headache, and facial pain.
- Wegener's Granulomatosis: A rare autoimmune disorder that can cause sinusitis, among other symptoms, due to inflammation of the blood vessels.