Differential Diagnosis
- Single most likely diagnosis
- Acute bacterial sinusitis: The patient's symptoms of increasing nasal congestion, sinus pressure, and fever over the past 2 days, along with tenderness over the maxillary and frontal sinus, are consistent with acute bacterial sinusitis. The recent history of hand-foot-and-mouth disease may have predisposed him to secondary bacterial infection.
- Other Likely diagnoses
- Viral sinusitis: Given the patient's initial symptoms of nasal congestion and drainage, viral sinusitis is a possible diagnosis. However, the increasing severity of symptoms and fever suggest a possible secondary bacterial infection.
- Influenza: The patient's symptoms of fever, nasal congestion, and sinus pressure could be consistent with influenza, especially during the flu season.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Meningitis: Although the patient's neck stiffness has improved, it is essential to consider meningitis, especially given the initial symptom. However, the absence of other symptoms like severe headache, photophobia, and altered mental status makes it less likely.
- Orbital cellulitis: The patient's symptoms of sinus pressure and tenderness over the maxillary and frontal sinus could be indicative of orbital cellulitis, which is a serious infection that requires prompt treatment.
- Rare diagnoses
- Sinusitis caused by atypical organisms (e.g., fungal sinusitis): Although rare, fungal sinusitis can occur, especially in immunocompromised patients. However, there is no indication of immunocompromise in this patient.
- Lemierre's syndrome: This is a rare condition characterized by bacterial pharyngitis followed by septic thrombophlebitis of the internal jugular vein. Although the patient has a history of hand-foot-and-mouth disease, there is no indication of pharyngitis or other symptoms suggestive of Lemierre's syndrome.