Differential Diagnoses for Bilateral Leg Pain with Respiratory Symptoms

Primary Diagnostic Considerations

The American College of Chest Physicians suggests that postinfectious cough should be considered as the primary diagnosis when cough persists following an acute respiratory infection for at least 3 weeks but not more than 8 weeks, with symptoms including viral myalgias or influenza-like illness 1, 2.
The European Respiratory Society indicates that multiple pathogenetic factors contribute to postinfectious cough, including postviral airway inflammation with bronchial hyper-responsiveness, mucus hypersecretion, and impaired mucociliary clearance 1, 2.

The American College of Physicians recommends that a chest radiograph is essential to differentiate pneumonia from acute bronchitis, as the presence of infiltrates fundamentally changes management 3.
The European Respiratory Society suggests checking vital signs, including heart rate, respiratory rate, and temperature, to differentiate between pneumonia and simple bronchitis 7, 6, 3.

The American College of Chest Physicians recommends considering inhaled ipratropium to attenuate the cough in uncomplicated postinfectious cough 1, 2.
The American College of Chest Physicians suggests considering inhaled corticosteroids if cough adversely affects quality of life and persists despite ipratropium 1, 2.

The American Academy of Family Physicians advises against assuming purulent sputum indicates bacterial infection requiring antibiotics, as sputum color alone does not reliably predict bacterial etiology 4, 3.
The American College of Physicians recommends against missing pneumonia by failing to obtain chest radiograph when productive cough is present with systemic symptoms like bilateral leg pain/myalgias 3.
The Infectious Diseases Society of America advises against prescribing additional antibiotics without evidence of bacterial superinfection (fever >3 days, worsening symptoms, or radiographic pneumonia) 1, 2, 4.