Differential Diagnosis for a 7-year-old with 4 days of fevers, nausea, sore throat, headache, fatigue, and myalgias
- Single most likely diagnosis:
- Viral pharyngitis (e.g., adenovirus, rhinovirus, or coronavirus): This is the most likely diagnosis given the combination of symptoms such as sore throat, fever, and myalgias, which are common in viral infections.
- Other Likely diagnoses:
- Influenza: The symptoms of fever, sore throat, headache, fatigue, and myalgias are consistent with influenza, especially during flu season.
- Streptococcal pharyngitis: Although less common than viral causes, streptococcal pharyngitis (strep throat) can present with similar symptoms and should be considered, especially if the sore throat is severe or accompanied by a rash.
- Mononucleosis (infectious mononucleosis): Caused by Epstein-Barr virus, this condition can present with fever, sore throat, fatigue, and myalgias, particularly in older children and adolescents.
- Do Not Miss diagnoses:
- Bacterial meningitis: Although less likely, bacterial meningitis is a life-threatening condition that can present with fever, headache, and fatigue. Early recognition and treatment are crucial.
- Kawasaki disease: This condition, which mainly affects children under 5 but can occur in older children, presents with fever, rash, and other symptoms. It's a do-not-miss diagnosis due to the risk of cardiac complications if not treated promptly.
- Lemierre's syndrome: A rare but serious condition that starts with pharyngitis and can progress to sepsis and thrombophlebitis, it's essential to consider in cases of severe or persistent sore throat.
- Rare diagnoses:
- Leptospirosis: A bacterial infection that can cause fever, headache, and myalgias, among other symptoms. It's rare but can be severe and is typically associated with exposure to contaminated water.
- Rocky Mountain spotted fever: A tick-borne illness that can present with fever, headache, and rash. It's rare but can be deadly if not treated promptly.
- Toxic shock syndrome: A severe condition caused by bacterial toxins, which can present with fever, rash, and multi-organ involvement. It's rare but life-threatening and requires immediate medical attention.