Differential Diagnosis for 15 y/o Boy with Fever, Redness of Eyes, Runny Nose, and Other Symptoms

• Single Most Likely Diagnosis
  • Influenza: The symptoms of fever, redness of eyes, runny nose, and the fact that the cousins have similar symptoms which have resolved, suggest a viral infection. The presence of bilateral conjunctivitis, small white spots on the palate and buccal mucosa, and erythema of the palate could be indicative of influenza, especially given the recent international travel which increases the risk of exposure to different strains of the virus.
• Other Likely Diagnoses
  • Adenoviral Pharyngoconjunctival Fever: This condition is characterized by fever, pharyngitis, and conjunctivitis, which aligns with some of the patient's symptoms. The small white spots on the palate and buccal mucosa could be part of the pharyngitis presentation.
  • Enteroviral Infection: Enteroviruses can cause a range of symptoms including fever, conjunctivitis, and pharyngitis. The recent travel and exposure to family members with similar symptoms support a contagious viral etiology.
• Do Not Miss Diagnoses
  • Kawasaki Disease: Although less common, Kawasaki disease is a critical diagnosis not to miss due to its potential for causing coronary artery aneurysms. It presents with fever, conjunctivitis, erythema of the oral and pharyngeal mucosa, and can sometimes include a rash and lymphadenopathy. The absence of a rash and lymphadenopathy in this case makes it less likely, but it should still be considered.
  • Infectious Mononucleosis: Caused by Epstein-Barr virus, it can present with fever, sore throat, and sometimes conjunctivitis. The presence of small white spots on the palate could be suggestive of infectious mononucleosis, especially if accompanied by lymphadenopathy and fatigue, although these are not mentioned.
• Rare Diagnoses
  • Scarlet Fever: Characterized by a sandpapery rash, fever, and strawberry tongue, which could initially present with erythema of the palate. However, the absence of a rash and the specific mention of small white spots make this less likely.
  • Leptospirosis: Given the recent international travel, leptospirosis could be considered, especially if the patient had exposure to contaminated water. However, the symptoms provided do not strongly suggest this diagnosis, which typically includes severe headache, muscle aches, and in severe cases, meningitis or kidney and liver failure.