Differential Diagnosis for a 6-year-old Female Presenting with Acute Watery Ear (AWE) and Elevated WBC Count
When discussing the diagnosis with parents, it's essential to be clear and concise. Here's a suggested approach: You can say, "Your child's lab results show an elevated white blood cell count, which could indicate an infection, but all other tests came back normal. We need to consider several possibilities, including viral or bacterial infections, to determine the best course of action."
Differential Diagnoses:
- Single most likely diagnosis:
- Viral upper respiratory infection: This is a common cause of elevated WBC counts in children, and the presentation of AWE could be related to Eustachian tube dysfunction often seen in upper respiratory infections.
- Other Likely diagnoses:
- Bacterial otitis media: Given the presentation of AWE, this could be a likely cause, especially if the elevated WBC count is indicative of a bacterial infection.
- Viral gastroenteritis: Although the primary complaint is AWE, viral gastroenteritis can sometimes present with elevated WBC counts and could be considered if there are gastrointestinal symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Bacteremia or sepsis: Although less likely given the normal CBC and CMP except for the elevated WBC, it's crucial to consider and rule out bacteremia or sepsis due to the potential severity of these conditions.
- Meningitis: This is another critical condition that, although unlikely given the presentation, must be considered due to its severe consequences if missed.
- Rare diagnoses:
- Leukemia or lymphoma: These conditions can present with elevated WBC counts, but they are rare in children and would typically be accompanied by other abnormal lab findings.
- Autoimmune disorders: Certain autoimmune disorders could potentially cause an elevated WBC count, but these would be rare and likely accompanied by other symptoms and abnormal lab results.