Differential Diagnosis for a 5-year-old with Nasal Crease, Rhinorrhea, Chronic Cough, and Blue Hue to Nasal Mucosa

• Single Most Likely Diagnosis

  • Allergic Rhinitis: This condition is characterized by chronic rhinorrhea, nasal congestion, and cough, often accompanied by a nasal crease (also known as an allergic salute) due to frequent nose rubbing. The blue hue to the nasal mucosa could be indicative of venous engorgement seen in allergic reactions.

• Other Likely Diagnoses

  • Viral Upper Respiratory Infection (URTI): Common in children, URTIs can cause rhinorrhea, cough, and nasal congestion. The blue hue might be less common but could be seen in severe cases due to increased blood flow.
  • Non-Allergic Rhinitis: This includes a variety of conditions that cause chronic rhinorrhea without an allergic basis, such as environmental irritants or anatomical issues. Symptoms can mimic those of allergic rhinitis.

• Do Not Miss Diagnoses

  • Foreign Body in the Nose: Although less likely to cause a blue hue, a foreign body can lead to unilateral rhinorrhea and nasal congestion. It's a critical diagnosis to consider due to potential complications like infection or tissue damage.
  • Nasal Polyps: Though rare in children, nasal polyps can cause chronic rhinorrhea and nasal obstruction. They might not directly cause a blue hue but could contribute to chronic inflammation.
  • Cystic Fibrosis: This genetic disorder can cause chronic respiratory symptoms, including cough and rhinorrhea, due to thick mucus production. The blue hue could be related to chronic hypoxia or cyanosis in severe cases.

• Rare Diagnoses

  • Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis): A rare autoimmune disorder that can affect the respiratory tract, causing symptoms like chronic rhinorrhea and cough. The blue hue could be indicative of granulomatous inflammation.
  • Primary Ciliary Dyskinesia (Kartagener Syndrome): A genetic disorder affecting cilia function, leading to chronic respiratory infections and inflammation. While rare, it could explain chronic symptoms and potentially the blue hue due to chronic infection and inflammation.