Differential Diagnosis for 70-year-old Female with Nasal Congestion and Cough

• Single most likely diagnosis:
  • Acute Bacterial Sinusitis: The patient's symptoms of nasal congestion, postnasal drainage, thick yellow nasal discharge, cough worsened at night, headache, fatigue, and sinus pressure are consistent with acute bacterial sinusitis. The duration of symptoms (2 weeks) and the presence of thick yellow discharge also support this diagnosis.
• Other Likely diagnoses:
  • Viral Upper Respiratory Infection (URI): Although the patient has tried multiple over-the-counter medications, the symptoms could still be consistent with a viral URI, especially given the absence of fever and shortness of breath.
  • Allergic Rhinitis Exacerbation: The patient has a history of allergic rhinitis, and the current symptoms could represent an exacerbation of this condition, especially if triggered by environmental allergens.
  • Chronic Rhinitis: The patient's symptoms could also be consistent with chronic rhinitis, which may be non-allergic in nature and could be related to her age, environmental exposures, or other factors.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Invasive Fungal Sinusitis: Although rare, this condition can be life-threatening, especially in diabetic patients. The presence of nasal congestion, discharge, and sinus pressure warrants consideration of this diagnosis.
  • Nasopharyngeal Cancer: Although unlikely, nasopharyngeal cancer can present with similar symptoms, including nasal congestion, discharge, and cough. This diagnosis should be considered, especially if the patient has a history of smoking or other risk factors.
  • Tuberculosis (TB): TB can present with chronic cough, fatigue, and weight loss, although it is less likely given the patient's symptoms and lack of systemic symptoms like fever and night sweats.
• Rare diagnoses:
  • Sarcoidosis: This condition can present with sinusitis, cough, and fatigue, although it is rare and would typically be associated with other systemic symptoms.
  • Granulomatosis with Polyangiitis (GPA): Formerly known as Wegener's granulomatosis, GPA is a rare autoimmune disorder that can present with sinusitis, cough, and other systemic symptoms.
  • Primary Ciliary Dyskinesia: A rare genetic disorder that affects the function of cilia in the respiratory tract, leading to chronic sinusitis and respiratory infections.