Differential Diagnosis for a 36-year-old Female with Sore Throat
- Single most likely diagnosis:
- Viral pharyngitis: This is the most likely diagnosis given the patient's symptoms of sore throat, painful swallowing, eating, and talking, with no improvement on Claritin and ibuprofen. The absence of fever, nasal congestion, or rhinorrhea, and a negative rapid strep test, also points towards a viral etiology.
- Other Likely diagnoses:
- Bacterial pharyngitis (despite negative rapid strep): Although the rapid strep test was negative, it is not 100% sensitive, and a throat culture may still be positive. The patient's symptoms of worsening sore throat and tonsillar hypertrophy with erythema could still be consistent with bacterial pharyngitis.
- Mononucleosis: The patient's symptoms of sore throat, tonsillar hypertrophy, and erythema could be consistent with infectious mononucleosis, especially if the patient is experiencing fatigue or lymphadenopathy.
- Acute tonsillitis: The patient's symptoms of painful swallowing, eating, and talking, with tonsillar hypertrophy and erythema, could be consistent with acute tonsillitis.
- 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 painful swallowing could be consistent with epiglottitis, especially if the patient is experiencing difficulty breathing or stridor.
- Lemierre's syndrome: This is a rare but potentially life-threatening condition characterized by bacterial pharyngitis, followed by sepsis and thrombophlebitis of the internal jugular vein. The patient's symptoms of worsening sore throat and tonsillar hypertrophy could be consistent with Lemierre's syndrome.
- Peritonsillar abscess: This is a serious complication of tonsillitis that requires prompt recognition and treatment. The patient's symptoms of severe sore throat, painful swallowing, and tonsillar hypertrophy could be consistent with a peritonsillar abscess.
- Rare diagnoses:
- Gonococcal pharyngitis: This is a rare condition that can cause symptoms of sore throat, tonsillar hypertrophy, and erythema. The patient's symptoms could be consistent with gonococcal pharyngitis, especially if the patient has a history of sexually transmitted infections.
- Tuberculous pharyngitis: This is a rare condition that can cause symptoms of sore throat, tonsillar hypertrophy, and erythema. The patient's symptoms could be consistent with tuberculous pharyngitis, especially if the patient has a history of tuberculosis or immunocompromised state.