Differential Diagnosis for Mucopurulent Discharge with Blood in One Nostril of a 5-Year-Old

• Single Most Likely Diagnosis
  • Nasal Foreign Body: This is the most common cause of unilateral mucopurulent discharge with blood in children, as they often insert small objects into their nostrils, leading to irritation, infection, and bleeding.
• Other Likely Diagnoses
  • Allergic Rhinitis: Although typically bilateral, allergic rhinitis can sometimes present unilaterally and cause nasal discharge and occasional bleeding due to vigorous nose-blowing or scratching.
  • Viral Upper Respiratory Infection (URI): URIs are common in children and can cause nasal discharge and occasional bleeding due to the fragility of the nasal mucosa.
  • Bacterial Sinusitis: This can cause purulent nasal discharge and, less commonly, blood, especially if there is significant nasal mucosal irritation or infection.
• Do Not Miss Diagnoses
  • Nasal Tumor (e.g., Juvenile Nasopharyngeal Angiofibroma): Although rare, these tumors can cause recurrent, unilateral nasal bleeding and discharge. Early diagnosis is crucial for effective treatment.
  • Trauma: Accidental or non-accidental trauma to the nose can cause bleeding and discharge. It's essential to consider the history and examine the child appropriately.
  • Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis): A rare autoimmune disorder that can cause destructive lesions in the nasal passages, leading to discharge and bleeding.
• Rare Diagnoses
  • Leprosy: In endemic areas, leprosy can cause chronic nasal discharge and bleeding due to mucosal infiltration.
  • Sarcoidosis: A systemic disease that can rarely affect the nasal mucosa, causing granulomatous inflammation, discharge, and bleeding.
  • Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome): A genetic disorder characterized by the presence of multiple telangiectasias, which can bleed easily, potentially causing nasal discharge with blood.