What is the diagnosis for a 22-year-old female presenting with a 5-day history of pharyngitis, fatigue, rhinorrhea, and congestion, with a history of streptococcal (strep) infections, currently using throat lozenges and Tylenol (acetaminophen) for symptomatic relief, with a negative rapid strep test in the office and a pending throat culture?

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Last updated: May 10, 2025View editorial policy

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Differential Diagnosis for a 22-year-old female with sore throat, fatigue, rhinorrhea, and congestion

  • Single most likely diagnosis
    • Viral pharyngitis: This is the most likely diagnosis given the patient's symptoms of sore throat, fatigue, rhinorrhea, and congestion, which are common presentations of a viral upper respiratory infection. The negative rapid strep test and the presence of rhinorrhea and congestion also support this diagnosis.
  • Other Likely diagnoses
    • Acute sinusitis: The patient's symptoms of congestion and rhinorrhea could be indicative of acute sinusitis, especially if the symptoms have been persistent.
    • Influenza: Although not specifically mentioned, the patient's symptoms of sore throat, fatigue, and congestion could be consistent with influenza, especially during flu season.
    • Mononucleosis: Given the patient's age and symptoms of sore throat and fatigue, mononucleosis (caused by Epstein-Barr virus) is a possible diagnosis, although it would typically be accompanied by other symptoms such as lymphadenopathy and fever.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Bacterial epiglottitis: Although rare, bacterial epiglottitis is a life-threatening condition that requires prompt recognition and treatment. Symptoms can include severe sore throat, difficulty swallowing, and shortness of breath.
    • Lemierre's syndrome: This is a rare but serious condition characterized by a bacterial infection of the throat, followed by sepsis and thrombophlebitis of the internal jugular vein. It typically presents with severe sore throat, fever, and neck pain.
    • Peritonsillar abscess: This is a serious complication of tonsillitis that can cause severe sore throat, difficulty swallowing, and fever. It requires prompt drainage to prevent complications.
  • Rare diagnoses
    • Diphtheria: Although rare in developed countries, diphtheria is a bacterial infection that can cause severe sore throat, difficulty swallowing, and a membrane to form over the tonsils.
    • Tuberculous pharyngitis: This is a rare form of tuberculosis that can cause chronic sore throat, fever, and weight loss. It is more common in immunocompromised individuals or those from endemic areas.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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