Differential Diagnosis for 19-Month-Old with Gum Pain and Systemic Symptoms
Single Most Likely Diagnosis
- Teething with superimposed infection or irritation: The child's age and symptoms such as gum pain, picking at the site, and refusal of food are consistent with teething issues, especially with fully erupted front teeth. The relief found with cold items is also typical for teething pain. The current treatment for thrust and the presence of swollen glands and intermittent fever could indicate a secondary infection or a viral illness coinciding with teething.
Other Likely Diagnoses
- Dental abscess or infection: The symptoms of gum pain, refusal to eat, and relief with cold items could also suggest a dental abscess or infection, especially if the child has a history of poor oral hygiene or recent dental trauma.
- Herpetic gingivostomatitis: This condition, caused by the herpes simplex virus, can lead to gum pain, fever, and refusal to eat. The presence of swollen glands and intermittent fever supports this diagnosis.
- Hand, Foot, and Mouth Disease (HFMD): Although more commonly associated with lesions on the hands and feet, HFMD can cause oral pain and fever, fitting some of the child's symptoms.
Do Not Miss Diagnoses
- Ludwig's Angina: A severe infection of the tissues in the neck, which can cause pain, fever, and difficulty swallowing. It's a medical emergency that requires prompt treatment.
- Peritonsillar abscess: An abscess beside the tonsils that can cause severe throat pain, fever, and difficulty swallowing. It's a serious condition that needs immediate medical attention.
- Osteomyelitis of the jaw: A bone infection in the jaw that can cause pain, fever, and swelling. It's a serious condition that requires prompt antibiotic treatment and possibly surgery.
Rare Diagnoses
- Erythema Multiforme: A skin condition that can also affect the mucous membranes, causing oral ulcers and pain. It's less common in this age group and would typically be associated with other skin lesions.
- Autoimmune disorders (e.g., Juvenile Idiopathic Arthritis): These conditions can cause fever, swollen glands, and oral symptoms, but they are rare in this age group and would typically be associated with other systemic symptoms.
- Leukemia: A type of blood cancer that can cause fever, swollen glands, and oral pain due to thrombocytopenia or leukemic infiltration of the gums. It's a rare diagnosis that would require further investigation with blood tests and possibly a bone marrow biopsy.