Differential Diagnosis for Fever, Cough, and Chest Pain

The combination of fever, cough, and chest pain can be indicative of a variety of conditions, ranging from common respiratory infections to more serious and potentially life-threatening diseases. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Community-Acquired Pneumonia (CAP): This is often the first consideration for patients presenting with fever, cough, and chest pain, especially if the pain is pleuritic (worsens with deep breathing). CAP can be caused by a variety of pathogens, including bacteria, viruses, and atypical bacteria.

• Other Likely Diagnoses

  • Acute Bronchitis: Typically presents with a cough and may be accompanied by fever and chest discomfort. It's often viral in nature but can be caused by bacteria.
  • Influenza: Especially during flu season, influenza can cause fever, cough, and body aches, which might include chest pain.
  • Pleurisy: Inflammation of the pleura, which can cause sharp chest pain that worsens with breathing. It can be due to various causes, including viral infections, pneumonia, or pulmonary embolism.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Both conditions can cause cough and chest tightness, and if severe, may be accompanied by fever.

• Do Not Miss Diagnoses

  • Pulmonary Embolism (PE): A potentially life-threatening condition that can cause sudden onset of chest pain and shortness of breath. While not all patients with PE have fever, it's a diagnosis that must be considered, especially in patients with risk factors for thromboembolism.
  • Pneumothorax: Air in the pleural space can cause sudden chest pain and shortness of breath. It's more common in tall, thin males or in patients with underlying lung disease.
  • Lung Abscess: A localized, suppurative infection within the lung parenchyma, which can cause fever, cough, and chest pain, often with a more chronic presentation.
  • Tuberculosis (TB): Especially in endemic areas or in patients with risk factors (e.g., immunocompromised, recent travel to or from high-prevalence areas), TB can cause chronic cough, fever, and chest pain.

• Rare Diagnoses

  • Sarcoidosis: An autoimmune disease that can affect the lungs, causing cough, chest pain, and fever, among other symptoms.
  • Eosinophilic Pneumonia: A rare condition characterized by an accumulation of eosinophils in the lungs, which can cause fever, cough, and chest pain.
  • Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can involve the lungs and cause a variety of respiratory symptoms, including cough and chest pain.
  • Pulmonary Vasculitis: Conditions like Wegener's granulomatosis (now known as granulomatosis with polyangiitis) can cause a combination of respiratory and systemic symptoms, including fever, cough, and chest pain.

Each of these diagnoses has different implications for treatment and prognosis, emphasizing the importance of a thorough diagnostic evaluation to determine the underlying cause of a patient's symptoms.