Differential Diagnosis for a 9-Week Pregnant Patient with Vomiting, Congestion, and Coughing
Single Most Likely Diagnosis
- Viral upper respiratory infection: This is the most likely diagnosis given the symptoms of vomiting, congestion, and coughing in a pregnant patient. The symptoms are consistent with a common cold or viral upper respiratory infection, which is prevalent and typically self-limiting.
Other Likely Diagnoses
- Influenza: Given the symptoms of coughing, congestion, and potentially vomiting, influenza should be considered, especially during flu season. Pregnancy increases the risk of complications from influenza.
- Pregnancy-related hyperemesis: While morning sickness is common in pregnancy, some women experience more severe symptoms, known as hyperemesis gravidarum. This condition could explain the vomiting but might not fully account for the congestion and coughing unless there's an associated viral infection.
- Gastroenteritis: This could cause vomiting and potentially some respiratory symptoms if the patient has a concurrent or recent viral infection affecting both the gastrointestinal and respiratory systems.
Do Not Miss Diagnoses
- Pneumonia: Although less likely, pneumonia is a serious condition that requires prompt diagnosis and treatment, especially in pregnant women, who are at increased risk of complications. Symptoms can include cough, fever, and shortness of breath.
- Influenza pneumonia: A complication of influenza, particularly in pregnant women, which can lead to severe respiratory illness.
- Pulmonary embolism: Although rare, pulmonary embolism is a life-threatening condition that can present with cough and shortness of breath. Pregnancy increases the risk of venous thromboembolism.
Rare Diagnoses
- Cystic fibrosis exacerbation: If the patient has a known history of cystic fibrosis, an exacerbation could present with increased respiratory symptoms.
- Pertussis (Whooping Cough): Especially if the patient is not up to date on vaccinations, pertussis could be a consideration, particularly if the cough is severe and persistent.
- Tuberculosis: Although rare in many populations, tuberculosis can present with chronic cough and should be considered, especially if the patient has risk factors such as recent travel to or from areas with high TB prevalence, or if she is immunocompromised.