Differential Diagnosis for a 10-year-old with Nasal Congestion and Cough
- Single most likely diagnosis:
- Acute bacterial sinusitis: This is the most likely diagnosis given the patient's symptoms of nasal congestion, cough, increasing nasal drainage, fever, and several nosebleeds over the past 3 weeks, with worsening symptoms over the past 3 days. The presence of fever and purulent nasal discharge are key indicators of a bacterial infection.
- Other Likely diagnoses:
- Viral upper respiratory infection: Although the duration of symptoms is longer than typical for a viral upper respiratory infection, it is still possible, especially given the initial assumption of seasonal allergies.
- Allergic rhinitis: Despite the mother's initial assumption, the presence of fever and worsening symptoms suggest that allergies might not be the primary cause, but could still be a contributing factor.
- Influenza: Given the fever and respiratory symptoms, influenza should be considered, especially during flu season.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Meningitis: Although the patient does not have typical symptoms of meningitis such as headache, stiff neck, or altered mental status, any infection in the head and neck area can potentially spread to the meninges, making this a diagnosis that cannot be missed.
- Orbital cellulitis: This is an infection of the tissues surrounding the eye and can be a complication of sinusitis. Symptoms can include eye pain, swelling, and decreased vision, which are not mentioned but should be considered due to the severity of the potential condition.
- Lemierre's syndrome: A rare but serious condition that involves a bacterial infection of the throat, which can lead to thrombophlebitis of the internal jugular vein and potentially life-threatening complications.
- Rare diagnoses:
- Wegener's granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause respiratory and nasal symptoms, among other systemic issues.
- Nasal foreign body: Although more common in younger children, a foreign body in the nose could cause persistent nasal discharge and other symptoms, and should be considered if other diagnoses are ruled out.
- Cystic fibrosis: A genetic disorder that can cause chronic respiratory and sinus infections, among other symptoms. This would be an unlikely diagnosis given the acute presentation, but could be considered if the patient has a history of recurrent infections.