Differential Diagnosis for 67-year-old Female with Respiratory Symptoms
- Single most likely diagnosis:
- Acute Bacterial Sinusitis: The patient's symptoms of nasal congestion, clear rhinorrhea, mild cough, increasing sinus pressure over the right side of her face, and thick green/tan drainage are consistent with acute bacterial sinusitis, especially given the duration of symptoms and the presence of purulent discharge.
- Other Likely diagnoses:
- Viral Upper Respiratory Infection: Although the patient's symptoms have been present for over a week and have progressed to include purulent discharge, a viral upper respiratory infection could still be a consideration, especially if the bacterial infection is secondary to a viral illness.
- Allergic Rhinitis: Given the patient's history of seasonal allergies, allergic rhinitis could be contributing to her symptoms, particularly the nasal congestion and clear rhinorrhea, although the presence of thick green/tan drainage and increasing sinus pressure suggests a more infectious process.
- Acute Viral Sinusitis: This could be a consideration if the symptoms were more recent and without the presence of purulent discharge, but the progression of symptoms and the nature of the discharge point more towards a bacterial cause.
- Do Not Miss diagnoses:
- Orbital Cellulitis: Although less likely, the presence of sinus pressure and facial pain, especially if severe or accompanied by other symptoms such as fever, proptosis, or decreased vision, necessitates consideration of orbital cellulitis, a serious infection that requires prompt medical attention.
- Cavernous Sinus Thrombosis: This rare but potentially life-threatening condition can occur as a complication of sinusitis, especially if there is evidence of severe infection, high fever, or neurological symptoms.
- Malignancy (e.g., Sinus Cancer): Given the patient's history of breast cancer, although the current symptoms are more suggestive of an infectious process, any persistent or unexplained symptoms, especially in a patient with a history of cancer, should prompt consideration of malignancy.
- Rare diagnoses:
- Fungal Sinusitis: This could be a consideration in an immunocompromised patient or one with specific risk factors (e.g., diabetes, prolonged use of corticosteroids), but it is less likely given the patient's presentation and history.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A systemic vasculitis that can involve the sinuses, but it would typically present with more systemic symptoms and findings, such as renal involvement or skin lesions.
- Sinusitis due to Uncommon Pathogens: Such as tuberculosis or syphilis, which would be unusual in this clinical context without specific risk factors or exposure history.