Differential Diagnosis for 7-year-old Male with Nasal Congestion, Rhinorrhea, and Eyelid Swelling
- Single most likely diagnosis:
- Allergic reaction (likely food-related): The patient's symptoms of nasal congestion, rhinorrhea, mild cough, eyelid swelling, and hives, especially after consuming a meal at school, suggest an allergic reaction. The recent introduction of new foods (meatball sub, watermelon, potatoes) could be the culprit, given the patient's uncertainty about previous consumption.
- Other Likely diagnoses:
- Viral upper respiratory infection: The initial symptoms of nasal congestion, rhinorrhea, and mild cough could be indicative of a viral upper respiratory infection, which is common in children. The subsequent development of eyelid swelling and hives might be coincidental or related to a secondary allergic response.
- Seasonal allergies: Although the mother reports mild seasonal allergies, it's possible that the patient's symptoms are exacerbated by current allergens, leading to more pronounced reactions, including eyelid swelling and hives.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Anaphylaxis: Although the patient's symptoms do not currently indicate anaphylaxis (no mention of difficulty breathing, rapid heartbeat, or a drop in blood pressure), any allergic reaction has the potential to escalate into anaphylaxis, which is life-threatening and requires immediate intervention.
- Angioedema: This condition, which can be allergic or non-allergic in nature, involves the rapid swelling of the dermis, subcutaneous tissue, mucosa, and submucosal tissues. It can lead to airway obstruction if not promptly treated, especially if the swelling affects the throat or tongue.
- Rare diagnoses:
- Hereditary angioedema: A rare genetic disorder characterized by recurrent episodes of severe swelling, it could be considered if the patient's symptoms of eyelid swelling and hives are part of a larger pattern of unexplained swelling episodes, especially if there's a family history.
- Autoimmune disorders (e.g., lupus, dermatomyositis): Although extremely rare in children and not directly suggested by the current symptoms, autoimmune disorders can sometimes present with a variety of skin and mucosal symptoms, including swelling and rashes.