Differential Diagnosis for a 3-day-old Girl with Copious, Purulent Eye Drainage
- Single most likely diagnosis:
- Neonatal conjunctivitis (ophthalmia neonatorum) due to chemical or infectious causes: This is the most likely diagnosis given the presentation of bilateral eyelid edema, conjunctival injection, and purulent discharge in a newborn, especially considering the lack of prophylactic erythromycin ointment which is commonly used to prevent gonococcal and chlamydial conjunctivitis.
- Other Likely diagnoses:
- Chlamydial conjunctivitis: A common cause of ophthalmia neonatorum, transmitted from the mother to the newborn during vaginal delivery. The absence of erythromycin ointment prophylaxis increases the risk.
- Gonococcal conjunctivitis: Although less common than chlamydial conjunctivitis, it is a significant consideration due to its potential for severe consequences, including corneal perforation, if not promptly treated.
- Viral conjunctivitis: Herpes simplex virus (HSV) can cause conjunctivitis in newborns, often associated with other signs of HSV infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Herpes simplex virus (HSV) infection: While less common, HSV can cause severe and potentially blinding conjunctivitis, as well as systemic infection. Prompt diagnosis and treatment are crucial.
- Gonococcal sepsis: Although the patient does not currently show signs of sepsis, gonococcal infection can lead to systemic disease, making it a critical diagnosis not to miss.
- Rare diagnoses:
- Congenital syphilis: Can cause conjunctivitis among other symptoms, but is less common due to prenatal screening and treatment.
- Keratoconjunctivitis due to other bacteria: Other bacterial causes like Pseudomonas or Streptococcus can cause conjunctivitis but are less common in this context.
- Fungal conjunctivitis: Extremely rare in newborns but could be considered in cases where standard treatments fail and in immunocompromised patients.