Differential Diagnosis for a 9-year-old Female with Nasal Congestion, Rhinorrhea, Mild Cough, and Eye Irritation
- Single most likely diagnosis:
- Viral conjunctivitis: This is the most likely diagnosis given the symptoms of eye irritation, redness, and crusting, especially in the context of an upper respiratory infection (nasal congestion, rhinorrhea, mild cough). The absence of fever, visual changes, or pain also supports this diagnosis.
- Other Likely diagnoses:
- Bacterial conjunctivitis: Although less likely than viral conjunctivitis due to the lack of purulent discharge description, it remains a possibility, especially if the condition worsens or does not improve with supportive care.
- Allergic conjunctivitis: Given the seasonal nature of allergies and the presence of nasal symptoms, allergic conjunctivitis could be considered, especially if there's a history of allergies.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Orbital cellulitis: Although the patient denies pain or visual changes, orbital cellulitis is a serious condition that requires prompt recognition and treatment. It can present with similar symptoms, including eye redness and swelling, and is a medical emergency.
- Herpes simplex keratitis: This condition can lead to serious complications, including vision loss, and should be considered in the differential, especially if there's any history of herpes simplex infection or if the patient develops significant eye pain or vision changes.
- Rare diagnoses:
- Kawasaki disease: This is a rare condition that can present with conjunctivitis, among other symptoms like fever, rash, and lymphadenopathy. Although the patient is afebrile, Kawasaki disease is a diagnosis that should be considered in the broader differential, especially if other symptoms develop.
- Sjögren's syndrome: An autoimmune disorder that can cause conjunctivitis, among other symptoms. It's rare in children and would typically present with more systemic symptoms, but it remains a consideration in the differential diagnosis of chronic or recurrent conjunctivitis.