Differential Diagnosis for a 64-year-old patient with cough and painful deglutition
Single most likely diagnosis
- Acute Pharyngitis: The patient's symptoms of cough and painful deglutition (difficulty swallowing) are classic for acute pharyngitis, which is often caused by viral or bacterial infections. The normal white blood cell count (WBC) with a slight increase in ESR supports this diagnosis, as it indicates a mild inflammatory response.
Other Likely diagnoses
- Acute Tonsillitis: Similar to pharyngitis, tonsillitis can cause painful swallowing and cough. The presence of a mild increase in ESR and a normal WBC count could support a viral or bacterial cause.
- Acute Laryngitis: This condition, characterized by inflammation of the larynx, can cause cough and painful swallowing. The patient's symptoms and lab results do not strongly indicate laryngitis but it remains a possibility.
- Gastroesophageal Reflux Disease (GERD): GERD can cause symptoms of painful swallowing and cough due to acid reflux. Although the lab results do not directly support GERD, it is a common condition that could explain the patient's symptoms.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Epiglottitis: Although less common, epiglottitis is a life-threatening condition that requires immediate attention. It can cause severe difficulty swallowing and cough. The patient's symptoms and lab results do not strongly indicate epiglottitis, but it should be considered due to its potential severity.
- Lung Cancer or Esophageal Cancer: In a 64-year-old patient, it is crucial not to miss a potential malignancy. Although the current symptoms and lab results do not strongly suggest cancer, further investigation might be warranted based on the patient's age and symptoms.
- Pneumonia: Community-acquired pneumonia could present with cough and, if the infection involves the upper lobes or is severe, could cause painful swallowing. The normal WBC count does not rule out pneumonia, especially if the patient is elderly or has a compromised immune system.
Rare diagnoses
- Infectious Mononucleosis: Caused by Epstein-Barr virus, this condition can lead to sore throat and difficulty swallowing. However, it typically presents in younger individuals and is accompanied by fatigue, fever, and lymphadenopathy.
- Diphtheria: A rare bacterial infection that can cause a severe sore throat and difficulty swallowing. It is less common in areas with good vaccination coverage but should be considered in travelers or those with incomplete vaccination histories.
- Tuberculosis (TB): TB can cause chronic cough and, in rare cases, painful swallowing if it involves the larynx or esophagus. The diagnosis would be supported by additional symptoms such as weight loss, night sweats, and exposure history.