Differential Diagnosis for Persistent Sore Throat
Single Most Likely Diagnosis
- Mononucleosis (Infectious Mononucleosis): This condition, caused by the Epstein-Barr virus (EBV), is common in young adults and can present with persistent sore throat, fatigue, and mild symptoms. The lack of response to steroid treatment and negative strep throat tests, along with the duration of symptoms, makes this a plausible diagnosis.
Other Likely Diagnoses
- Viral Pharyngitis: Given the patient's age and symptoms, a viral cause for the pharyngitis is possible. The absence of a response to steroid treatment and negative strep tests supports this, as viral infections do not respond to antibiotics or steroids.
- Tonsillitis: Recurrent or persistent tonsillitis could explain the patient's symptoms, especially if the tonsils are enlarged or have exudates. The alternating side of soreness could indicate a tonsillar issue.
- Laryngopharyngeal Reflux (LPR): Although less common in young adults without other symptoms of gastroesophageal reflux disease (GERD), LPR could cause persistent sore throat and scratchiness, especially if the patient has any triggers such as dietary factors.
Do Not Miss Diagnoses
- HIV Infection: Although the patient denies STI risk, HIV can present with persistent sore throat among other symptoms. It's crucial to consider HIV in the differential due to its significant implications on health and treatment.
- Lymphoma: Though rare, lymphomas can present with persistent sore throat, fatigue, and other nonspecific symptoms. Given the potential severity of this diagnosis, it should not be overlooked.
- Tuberculosis (TB): TB can cause a chronic sore throat, among other symptoms. Although less likely without exposure history or systemic symptoms, it's a diagnosis that should be considered due to its public health implications and the need for specific treatment.
Rare Diagnoses
- Sarcoidosis: This autoimmune disease can affect various parts of the body, including the throat, and cause persistent soreness. However, it's less common and usually accompanied by other systemic symptoms.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): A rare autoimmune disorder that can cause a variety of symptoms, including sore throat. It's unlikely without other systemic symptoms or findings but is included due to its severity and need for specific treatment.
- Kawasaki Disease: Although primarily seen in children, Kawasaki disease can rarely occur in young adults and may present with sore throat among other symptoms. It's a diagnosis that requires prompt recognition due to the risk of cardiac complications.