Differential Diagnosis for a 37-year-old Female with Dry Hacky Cough and Itchy Watery Eyes
- Single most likely diagnosis:
- Allergic rhinitis: The patient's symptoms of itchy watery eyes and dry hacky cough, along with the lack of response to loratadine, suggest that her allergies might not be adequately controlled, or she might have developed tolerance to the medication. The chronic nature of her symptoms also points towards allergic rhinitis.
- Other Likely diagnoses:
- Vasomotor rhinitis: This condition can cause similar symptoms to allergic rhinitis but is not triggered by allergies. It could be a consideration if the patient's symptoms persist despite adequate allergy treatment.
- Sinusitis: Chronic sinusitis could cause a persistent cough and eye symptoms, especially if there is postnasal drip irritating the throat.
- Asthma: Cough can be a predominant symptom of asthma, and itchy watery eyes could be related to allergies that also trigger asthma.
- Do Not Miss diagnoses:
- Angiotensin-converting enzyme (ACE) inhibitor-induced cough: Although the patient is taking OTC loratadine, it's crucial to inquire about other medications, including ACE inhibitors, which are known to cause a dry, persistent cough in some patients.
- Tuberculosis or other infectious diseases: A chronic cough can be a symptom of tuberculosis or other infectious diseases. Although less likely, these conditions are critical to rule out due to their serious nature.
- Rare diagnoses:
- Sjögren's syndrome: An autoimmune disorder that can cause dry eyes and respiratory symptoms, including cough, due to decreased mucous production.
- Eosinophilic esophagitis: Could potentially cause a chronic cough, although it's more commonly associated with dysphagia and food impaction.
- Occupational or environmental exposures: Certain exposures at work or home could lead to chronic respiratory and eye symptoms, such as those seen in occupational asthma or due to irritants like pesticides or heavy metals.