Differential Diagnosis for a 1-week-old Infant with Eyelid Swelling and Purulent Discharge
- Single most likely diagnosis:
- Neisseria gonorrhea conjunctivitis: This is the most likely diagnosis due to the presence of moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge in a 1-week-old infant. Neisseria gonorrhea conjunctivitis is a common cause of conjunctivitis in newborns, especially if the mother has an untreated gonococcal infection.
- Other Likely diagnoses:
- Chlamydia trachomatis conjunctivitis: This is another common cause of conjunctivitis in newborns, typically presenting with mucopurulent discharge and conjunctival inflammation. It is a likely diagnosis, but less so than Neisseria gonorrhea given the severity of symptoms described.
- Chemical-induced conjunctivitis: Although less likely given the description of thick, purulent discharge, chemical-induced conjunctivitis (e.g., from silver nitrate prophylaxis) could present with eyelid swelling and conjunctival injection. However, the discharge is typically more watery and less purulent.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Herpes simplex virus (HSV) conjunctivitis: Although less common, HSV conjunctivitis can have severe consequences, including corneal perforation and vision loss, if not promptly treated. It typically presents with vesicular skin lesions, but these may not always be present.
- Rare diagnoses:
- Other bacterial causes (e.g., Haemophilus influenzae, Streptococcus pneumoniae) could potentially cause conjunctivitis in a newborn, but these are less common and would typically be considered after the more likely causes have been ruled out.
- Keratoconjunctivitis due to other pathogens (e.g., Pseudomonas aeruginosa) could also be considered, but these are rare in the context of a well-baby assessment and would typically require specific risk factors or exposures.