Differential Diagnosis for Sore Throat, Headache, Red Tonsils, and Axillary Lymphadenopathy
Single Most Likely Diagnosis
- Viral Pharyngitis: This is the most common cause of sore throat and is often accompanied by headache, red tonsils, and lymphadenopathy. The symptoms have been present for 7 days, which is consistent with the typical duration of viral pharyngitis.
Other Likely Diagnoses
- Streptococcal Pharyngitis: Although less common than viral pharyngitis, streptococcal pharyngitis (caused by Group A beta-hemolytic streptococcus) is a significant consideration, especially if the patient has a fever, tender lymph nodes, and a lack of cough. The presence of red tonsils and lymphadenopathy supports this diagnosis.
- Infectious Mononucleosis: Caused by Epstein-Barr virus, infectious mononucleosis can present with sore throat, fever, headache, and lymphadenopathy, including axillary lymph nodes. The duration of symptoms and the combination of sore throat with lymphadenopathy make this a plausible diagnosis.
- Adenoviral Infection: Adenoviruses can cause a range of respiratory illnesses, including pharyngitis, which may be accompanied by headache, fever, and lymphadenopathy.
Do Not Miss Diagnoses
- Lemierre's Syndrome: A rare but potentially life-threatening condition that starts with pharyngitis and progresses to septicemia and thrombophlebitis of the internal jugular vein. Early recognition is crucial, and the presence of severe sore throat and lymphadenopathy warrants consideration of this diagnosis.
- HIV Infection (Acute Retroviral Syndrome): Acute HIV infection can present with non-specific symptoms including sore throat, headache, fever, and lymphadenopathy. Given the potential for severe consequences if left untreated, it's essential to consider HIV in the differential diagnosis, especially in high-risk individuals.
- Tuberculosis: Although less common, tuberculosis (TB) can cause lymphadenopathy and systemic symptoms like headache and fever. TB pharyngitis is rare but should be considered, especially in individuals with risk factors for TB exposure.
Rare Diagnoses
- Toxoplasmosis: Typically causes asymptomatic infection, but in some cases, especially in immunocompromised individuals, it can lead to lymphadenopathy and systemic symptoms.
- Cytomegalovirus (CMV) Infection: Similar to infectious mononucleosis, CMV can cause a mononucleosis-like syndrome with sore throat, lymphadenopathy, and systemic symptoms, primarily in immunocompromised individuals or those without prior immunity.
- Syphilitic Pharyngitis: A rare manifestation of primary syphilis, which can cause sore throat and lymphadenopathy. This diagnosis should be considered in individuals with high-risk sexual behavior or exposure history.