Differential Diagnosis for Intermittent Upper Respiratory Symptoms
- Single Most Likely Diagnosis
- Viral upper respiratory tract infection (URTI) with secondary bacterial sinusitis: This is the most likely diagnosis given the initial intense symptoms followed by a brief improvement and then recurrence with sinus pressure, suggesting a possible secondary bacterial infection.
- Other Likely Diagnoses
- Allergic rhinitis: The symptoms could be consistent with an allergic reaction, especially if the patient is exposed to specific allergens that trigger the symptoms.
- Viral sinusitis: Similar to URTI, but with a focus on sinus symptoms, which could explain the sinus pressure.
- Influenza: Although influenza typically presents with more systemic symptoms like fever and body aches, some cases can manifest primarily as upper respiratory symptoms.
- Do Not Miss Diagnoses
- Bacterial sinusitis: While considered in the most likely diagnosis, it's crucial to distinguish between viral and bacterial causes due to the need for antibiotics in bacterial cases.
- Pneumonia: Although less likely given the description, pneumonia can present with upper respiratory symptoms initially and is a critical diagnosis not to miss due to its potential severity.
- Tuberculosis (TB): Though rare, TB can cause chronic or recurrent upper respiratory symptoms and is a diagnosis that must be considered, especially in high-risk populations.
- Rare Diagnoses
- Immunoglobulin A (IgA) deficiency: A rare immune deficiency that can lead to recurrent infections, including sinusitis.
- Cystic fibrosis: A genetic disorder that can cause recurrent respiratory infections, including sinusitis, due to abnormal mucus production.
- Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis): A rare autoimmune disorder that can cause sinusitis among other symptoms.
- Sarcoidosis: An autoimmune disease that can affect multiple parts of the body, including the sinuses, leading to chronic inflammation.