Differential Diagnosis for 8-year-old Female with Worsening Cough
- Single most likely diagnosis:
- Viral upper respiratory infection (URI): This is the most likely diagnosis given the symptoms of worsening cough, nasal congestion, and rhinorrhea without fever, shortness of breath, or wheezing. The lack of response to Zyrtec also points towards a viral etiology rather than allergic.
- Other Likely diagnoses:
- Allergic rhinitis: Although the patient has taken Zyrtec with no improvement, allergic rhinitis could still be considered, especially given her history of asthma. The symptoms of nasal congestion and rhinorrhea could be indicative of an allergic reaction.
- Asthma exacerbation: Given her past medical history of asthma, an exacerbation could present with a cough, especially if it's described as harsh and wet. However, the absence of wheezing or shortness of breath makes this less likely.
- Sinusitis: This could be a consideration if the viral URI has led to a secondary bacterial infection of the sinuses, although the duration of symptoms and lack of fever make this less likely at this stage.
- Do Not Miss diagnoses:
- Pneumonia: Although the patient denies shortness of breath or fever, pneumonia could present atypically, especially in someone with a history of immunocompromised state due to previous AML. It's crucial to consider this diagnosis due to its potential severity.
- Invasive fungal sinusitis: Given her history of AML, which may have required immunosuppressive treatment, there's a risk of opportunistic infections, including invasive fungal sinusitis. This condition is rare but potentially deadly and requires prompt diagnosis and treatment.
- Reactivation of tuberculosis (TB): If the patient was exposed to TB during her treatment for AML, especially if she was in an area with high TB prevalence, reactivation could occur. TB can present with a chronic cough, among other symptoms.
- Rare diagnoses:
- Cystic fibrosis: Although less likely given her age and the fact that she hasn't been diagnosed with it before, cystic fibrosis could present with recurrent respiratory infections and a chronic cough.
- Primary ciliary dyskinesia: A rare genetic disorder that affects the motor function of cilia and can lead to recurrent respiratory infections and chronic cough.
- Lymphoma: Given her history of AML, there's a small risk of developing another type of cancer, such as lymphoma, which could present with a variety of symptoms including cough if it involves the lungs or mediastinum.