Differential Diagnosis for 7-Day Running Nose, Smoker, Non-Productive Cough, Greenish Nasal Discharge, Congestion, Facial Pain, and Headache

• Single Most Likely Diagnosis
  • Acute Bacterial Sinusitis: This condition is likely given the combination of symptoms such as greenish nasal discharge, facial pain, headache, and congestion, which are typical for a bacterial infection of the sinuses. The patient's history of smoking may also contribute to the development of sinusitis due to irritation and decreased mucociliary clearance.
• Other Likely Diagnoses
  • Acute Viral Rhinosinusitis (Common Cold): Although the greenish discharge might suggest a bacterial infection, the initial presentation could still be consistent with a viral upper respiratory infection, especially if the symptoms have not yet fully evolved or if the bacterial infection is secondary to a viral illness.
  • Allergic Rhinitis: This could be considered if the patient has a history of allergies, as it can cause similar symptoms such as running nose, congestion, and headache. However, the greenish nasal discharge and facial pain are less typical for allergic rhinitis.
  • Chronic Bronchitis: Given the patient's smoking history, chronic bronchitis could be a consideration, especially if the cough is persistent. However, the primary symptoms here seem more focused on the upper respiratory tract.
• Do Not Miss Diagnoses
  • Invasive Fungal Sinusitis: Although rare, this condition can be deadly, especially in immunocompromised patients. The presence of greenish discharge and facial pain could be indicative, and it's crucial to consider this diagnosis to avoid missing a potentially fatal condition.
  • Orbital Cellulitis or Abscess: These are serious complications of sinusitis that can lead to severe consequences, including vision loss. Symptoms such as facial pain, headache, and signs of orbital involvement (e.g., proptosis, diplopia) would necessitate urgent evaluation.
  • Meningitis: While less likely, given the headache and facial pain, meningitis could be considered, especially if there are signs of severe illness, fever, or neurological deficits.
• Rare Diagnoses
  • Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause sinusitis, cough, and other systemic symptoms. It would be considered if there were additional symptoms such as kidney issues or specific findings on imaging.
  • Sarcoidosis: This condition can cause sinusitis and cough among other symptoms, but it would typically be associated with other systemic findings or a known history of sarcoidosis.
  • Nasal Tumors: Although very rare, tumors in the nasal cavity or sinuses could cause similar symptoms, especially if there's a history of smoking. Persistent or worsening symptoms despite treatment would prompt further investigation.