Differential Diagnosis for the 43-year-old Female Patient
The patient presents with a complex set of symptoms including headache, eye pain, ear pain, nasal pain, facial discomfort, purulent nasal drainage, swelling of the eyelid, intermittent visual distortion, increased sensitivity and tightness in the facial area, neck pain, numbness, and pain in her hand. Given her recent completion of a course of azithromycin for a presumed sinus infection, the differential diagnosis can be organized into the following categories:
Single Most Likely Diagnosis
- Sinusitis (possibly complicated by orbital or intracranial extension): The patient's symptoms of purulent nasal drainage, facial pain, and recent treatment for a presumed sinus infection suggest sinusitis as a primary diagnosis. The presence of swelling of the eyelid and intermittent visual distortion could indicate complications such as orbital cellulitis or abscess.
Other Likely Diagnoses
- Migraine or Cluster Headache: The patient's description of unilateral headache, eye pain, and sensitivity could be indicative of a migraine or cluster headache, especially given the absence of prior headache history.
- Trigeminal Neuralgia: The facial pain and increased sensitivity could suggest trigeminal neuralgia, although the presence of other symptoms like purulent nasal drainage and visual distortion makes this less likely.
- Temporomandibular Joint (TMJ) Disorder: TMJ disorders can cause facial pain, ear pain, and headache, but the nasal symptoms and visual disturbances are not typical.
Do Not Miss Diagnoses
- Cavernous Sinus Thrombosis: This is a potentially life-threatening condition that can arise from sinusitis or facial infections. Symptoms can include headache, facial pain, visual disturbances, and cranial nerve palsies.
- Meningitis or Encephalitis: Infection spreading from the sinuses to the intracranial space could result in meningitis or encephalitis, presenting with symptoms like headache, fever, and potentially altered mental status or neurological deficits.
- Stroke or Transient Ischemic Attack (TIA): Although less likely given the patient's age and presentation, stroke or TIA could explain some of the neurological symptoms like numbness and visual disturbances.
Rare Diagnoses
- Tolosa-Hunt Syndrome: A rare condition characterized by headache, facial pain, and ophthalmoplegia due to nonspecific inflammation of the cavernous sinus or superior orbital fissure.
- Raeder’s Syndrome: A rare condition involving facial pain, miosis, and ptosis, typically due to a lesion affecting the sympathetic nerves in the face.
- Nasal or Sinus Tumors: Although rare, tumors in the nasal cavity or sinuses could cause a variety of symptoms including nasal obstruction, facial pain, and visual disturbances, depending on their location and size.