Differential Diagnosis for a 4-year-old with Viral Infection
Single most likely diagnosis
- Viral Gastroenteritis with Facial Involvement: This diagnosis is likely due to the combination of upset stomach, vomiting, and a rash on the face, which could be indicative of a viral infection affecting both the gastrointestinal system and the skin. The absence of a rash on the back and mouth sores helps to narrow down the possibilities.
Other Likely diagnoses
- Enteroviral Infection: Enteroviruses can cause a range of symptoms including gastrointestinal upset, rash, and facial involvement. The fact that the condition comes and goes in 5 days is consistent with many enteroviral infections.
- Adenoviral Infection: Adenoviruses can cause infections that lead to symptoms such as vomiting, rash, and facial involvement, including conjunctivitis or pharyngoconjunctival fever, which might explain the facial drooping if it's related to eye or facial muscle involvement.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Botulism: Although rare, botulism can cause facial drooping, gastrointestinal symptoms, and can be fatal if not treated promptly. The absence of mouth sores and the specific pattern of the rash do not rule out botulism entirely.
- Meningitis: While the symptoms do not strongly suggest meningitis, any infection that causes significant concern for neurological involvement (such as facial drooping) warrants consideration of meningitis due to its potential severity and the need for urgent treatment.
Rare diagnoses
- Kawasaki Disease: This is a rare condition that mainly affects children under the age of 5. It can cause rash, vomiting, and facial involvement, but it typically includes other symptoms such as fever, conjunctivitis, and changes to the lips and tongue, which are not mentioned here.
- Herpangina: Caused by coxsackieviruses, herpangina can lead to mouth sores and sometimes a rash, but the absence of mouth sores in this case makes it less likely. However, some strains might not cause the typical oral lesions.