Differential Diagnosis
- Single most likely diagnosis
- Viral pharyngitis: The patient's symptoms of sore throat, general malaise, and strong fatigue, along with a recent history of exposure to conjunctivitis and sinus congestion, and a negative Covid test and strep throat test, suggest a viral etiology. The initial improvement with a Z-pack, followed by recurrence of symptoms, may indicate a viral infection that was partially suppressed by the antibiotic.
- Other Likely diagnoses
- Bacterial pharyngitis (non-strep): Although the strep throat test was negative, other bacteria such as Haemophilus influenzae, Moraxella catarrhalis, or Fusobacterium necrophorum could be causing the patient's symptoms.
- Mononucleosis: The patient's symptoms of sore throat, fatigue, and general malaise, along with a recent history of fever, could be consistent with infectious mononucleosis, especially if the patient is young.
- Sinusitis: The patient's history of sinus congestion and recent exposure to conjunctivitis and sinus congestion from her granddaughter suggests that sinusitis could be a contributing factor to her symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lemierre's syndrome: This is a rare but potentially life-threatening condition caused by Fusobacterium necrophorum, which can cause pharyngitis, fever, and neck pain. Although unlikely, it is essential to consider this diagnosis due to its high mortality rate if left untreated.
- Epiglottitis: This is a rare but potentially life-threatening condition that can cause sore throat, fever, and difficulty swallowing. Although the patient does not have all the classic symptoms, it is essential to consider this diagnosis due to its high mortality rate if left untreated.
- Rare diagnoses
- Toxoplasmosis: This is a rare infection that can cause sore throat, fever, and general malaise, especially in immunocompromised individuals.
- Histoplasmosis: This is a rare fungal infection that can cause sore throat, fever, and general malaise, especially in individuals who have been exposed to bird or bat droppings.