Differential Diagnosis for Facial Swelling and Abdominal Pain

The patient presents with swelling in the left facial region, left eye, and upper lip, accompanied by a history of mid-abdominal pain. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Allergic reaction: The patient's symptoms of facial swelling, particularly after the mother mentions the possibility of an allergic reaction following the administration of Motrin (ibuprofen), suggest an allergic reaction as a plausible cause. Allergic reactions can range from mild to severe (anaphylaxis) and can involve various parts of the body, including the face.

• Other Likely Diagnoses

  • Insect bite or sting: The sudden onset of swelling, especially if the patient was outdoors or in an area where insects are present, could suggest an insect bite or sting.
  • Dental infection or abscess: An infection in the teeth or gums could cause swelling in the facial region, especially if it involves the upper teeth or gums.
  • Sinusitis: Inflammation or infection of the sinuses could lead to facial swelling, particularly around the eyes and cheeks.

• Do Not Miss Diagnoses

  • Angioedema: A condition characterized by the rapid swelling of the dermis, subcutaneous tissue, mucosa, and submucosal tissues. It can be life-threatening if it involves the airways. The patient's facial swelling, especially if it involves the lips and potentially the tongue or throat, necessitates consideration of angioedema.
  • Anaphylaxis: Although the patient's current symptoms do not fully align with anaphylaxis (which typically involves multiple systems and can include respiratory distress, cardiovascular instability, and gastrointestinal symptoms), any suspicion of a severe allergic reaction warrants consideration of anaphylaxis due to its potentially fatal outcome.
  • Orbital cellulitis: An infection of the tissues surrounding the eye, which can cause swelling, redness, and pain. It is a medical emergency due to the risk of serious complications, including vision loss.

• Rare Diagnoses

  • Erythema multiforme: A skin condition characterized by target lesions, which can sometimes involve the face and mucous membranes. It is often associated with infections or medications.
  • Wegener's granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause inflammation of the blood vessels, leading to a variety of symptoms including facial swelling, sinusitis, and abdominal pain.
  • Melkersson-Rosenthal syndrome: A rare neurological disorder characterized by recurrent, often unilateral, facial paralysis or weakness, facial edema, and the development of folds and furrows in the tongue (fissured tongue).