Differential Diagnosis for a 4-year-old child with high fever, stomach pain, runny nose, mild cough, and lethargy
- Single most likely diagnosis:
- Viral gastroenteritis or a viral upper respiratory infection with abdominal symptoms. The intermittent high fever, runny nose, mild cough, and stomach pain are common in viral infections, and the fact that the child can hold fluids and is peeing properly suggests that the condition, although severe, may not be immediately life-threatening.
- Other Likely diagnoses:
- Pneumonia: The presence of a mild cough and high fever could indicate pneumonia, especially if the abdominal pain is referred pain from the lower lungs.
- Urinary Tract Infection (UTI): Although the child is peeing properly, UTIs can present with abdominal pain and high fever, especially in young children.
- Influenza: Given the symptoms of high fever, runny nose, mild cough, and lethargy, influenza should be considered, especially during flu season.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Appendicitis: Although the child's ability to hold fluids and pee properly might suggest against severe dehydration or an acute abdomen, appendicitis can present with intermittent pain and fever, and missing this diagnosis could lead to severe consequences.
- Sepsis: Any child with high fever, lethargy, and signs of possible infection should be evaluated for sepsis, as it is a life-threatening condition requiring immediate intervention.
- Meningitis: High fever, lethargy, and severe illness could also suggest meningitis, especially if there are signs of neck stiffness or severe headache (though these might be hard to assess in a young child).
- Rare diagnoses:
- Kawasaki Disease: This condition presents with high fever, lethargy, and can have abdominal symptoms, though it is more commonly associated with rash, conjunctivitis, and lymphadenopathy.
- Systemic Juvenile Idiopathic Arthritis (sJIA): Can present with high fever, abdominal pain, and lethargy, though typically also includes a rash and joint symptoms.
- Leukemia: Though rare, leukemia can present with nonspecific symptoms including fever, abdominal pain (due to splenomegaly), and lethargy, making it a diagnosis that should not be overlooked in a child with persistent and severe symptoms.