Differential Diagnosis for a 6 Year Old Girl with Fever and Difficulty Breathing
Single Most Likely Diagnosis
- Epiglottitis: This condition is highly suspected due to the acute onset of high-grade fever, sore throat, and rapidly progressing difficulty breathing, characterized by "noisy breathing" (stridor). The inability to open her mouth (trismus) and the severe distress also point towards epiglottitis, especially in an unvaccinated child, as the risk of Haemophilus influenzae type b (Hib) infection, a common cause of epiglottitis, is higher.
Other Likely Diagnoses
- Croup: Given the history of similar, albeit milder, complaints in the past, croup is a consideration. However, the severity of symptoms, including high-grade fever and significant distress, makes epiglottitis more likely. Croup typically presents with a barking cough and hoarse voice, but the clinical picture can sometimes overlap.
- Tonsillitis or Peritonsillar Abscess: These conditions could explain the sore throat and fever but are less likely to cause the acute respiratory distress and stridor seen in this patient.
Do Not Miss Diagnoses
- Retropharyngeal Abscess: Although less common, this condition can present with similar symptoms, including difficulty breathing and neck stiffness. It is a medical emergency requiring prompt diagnosis and treatment.
- Bacterial Tracheitis: This condition can mimic epiglottitis and croup but often presents with a more gradual onset. It is a serious infection that requires early recognition and intervention.
- Foreign Body Aspiration: While the history does not specifically suggest aspiration, it is a critical diagnosis not to miss, as it can cause sudden onset of respiratory distress and can be fatal if not promptly treated.
Rare Diagnoses
- Diphtheria: Although rare in areas with high vaccination coverage, the fact that this child is unvaccinated makes it a consideration, especially with symptoms like sore throat and difficulty breathing. However, diphtheria typically presents with a membrane covering the tonsils and throat.
- Angioedema: This could cause airway obstruction and difficulty breathing but usually has associated skin findings and a different clinical context.
- Laryngomalacia or Other Congenital Anomalies: While these conditions can cause stridor, they typically present in infancy and are less likely to have an acute onset in a 6-year-old.