Differential Diagnosis for 53-year-old Female with Sore Throat and Productive Cough
- Single most likely diagnosis:
- Acute viral pharyngitis: This is the most likely diagnosis given the patient's symptoms of sore throat, productive cough, and fever, combined with negative rapid tests for strep, COVID, and influenza. The initial "razor blade" sensation with swallowing is consistent with a viral etiology.
- Other Likely diagnoses:
- Acute bronchitis: The development of a productive cough and fever suggests that the infection may have descended into the lower respiratory tract, making acute bronchitis a possible diagnosis.
- Viral laryngitis: The patient's symptoms of sore throat and cough could also be consistent with viral laryngitis, especially if the cough is dry and irritating.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Epiglottitis: Although rare, epiglottitis is a life-threatening condition that requires prompt recognition and treatment. The patient's symptoms of sore throat and difficulty swallowing could be consistent with epiglottitis, especially if there are signs of respiratory distress.
- Peritonsillar abscess: This is a serious complication of tonsillitis that can cause severe throat pain, difficulty swallowing, and fever. Although the rapid strep test was negative, a peritonsillar abscess is still possible and requires prompt evaluation.
- Pneumonia: The patient's symptoms of productive cough and fever could be consistent with pneumonia, especially if there are signs of respiratory distress or abnormal lung sounds on examination.
- Rare diagnoses:
- Lemierre's syndrome: This is a rare condition characterized by a bacterial infection of the throat, followed by sepsis and thrombophlebitis of the internal jugular vein. Although rare, it is a potentially life-threatening condition that requires prompt recognition and treatment.
- Tuberculosis: Although unlikely, tuberculosis (TB) can cause symptoms of sore throat, cough, and fever, especially in immunocompromised individuals. A thorough history and physical examination, combined with diagnostic testing, would be necessary to rule out TB.