What are the possible causes of pain on deglutition (swallowing) and fever in a patient with viral conjunctivitis?

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Last updated: May 19, 2025View editorial policy

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Differential Diagnosis for Viral Conjunctivitis with Pain on Deglutition and Fever

  • Single most likely diagnosis:
    • Herpangina: This condition is characterized by small, painful blisters or ulcers on the roof of the mouth and the back of the throat, which can cause pain on deglutition. It is often accompanied by fever and can occur concurrently with viral conjunctivitis, especially in the context of a viral infection such as coxsackievirus.
  • Other Likely diagnoses:
    • Pharyngitis: Viral or bacterial pharyngitis can cause pain on deglutition and fever. The presence of viral conjunctivitis suggests a viral etiology, but bacterial causes should also be considered.
    • Tonsillitis: Inflammation of the tonsils can cause severe pain on deglutition and is often accompanied by fever. It can be viral or bacterial in nature.
    • Mononucleosis: Caused by the Epstein-Barr virus, mononucleosis can lead to fever, sore throat, and conjunctivitis, although the conjunctivitis is less common.
  • 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 immediate medical attention. It can cause severe pain on deglutition and fever, and the presence of viral conjunctivitis does not rule out this diagnosis.
    • Lemierre's Syndrome: A rare but serious condition characterized by a bacterial infection of the throat, which can lead to sepsis and other complications. It typically presents with fever, sore throat, and neck pain.
  • Rare diagnoses:
    • Diphtheria: A bacterial infection that can cause a severe sore throat and fever. It is rare in areas with high vaccination rates but can be considered in unvaccinated individuals or those who have traveled to areas where diphtheria is common.
    • Stevens-Johnson Syndrome: A rare but serious disorder of the skin and mucous membranes, often triggered by an infection or medication. It can cause conjunctivitis, fever, and oral ulcers, leading to pain on deglutition.

Professional Medical Disclaimer

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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