Differential Diagnosis
- Single most likely diagnosis
- Peritonsillar abscess: The combination of a thick white coating on the tongue, inability to open the mouth fully (trismus), slight salivating, asymmetric posterior oropharynx, muffled voice, and a painful enlarged cervical lymph node are all consistent with a peritonsillar abscess. The hot potato voice is particularly suggestive of this condition.
- Other Likely diagnoses
- Tonsillitis: The symptoms of a sore throat, painful lymph node, and difficulty opening the mouth could also be consistent with tonsillitis, especially if the white coating on the tongue is due to debris or exudate from the tonsils.
- Pharyngitis: Inflammation of the pharynx could cause similar symptoms, including a muffled voice and painful lymph nodes.
- Oral candidiasis (thrush): While less likely given the other symptoms, the thick white coating on the tongue could be due to thrush, especially in immunocompromised patients.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Epiglottitis: Although less common, epiglottitis is a life-threatening condition that can cause similar symptoms, including a muffled voice and difficulty opening the mouth. It requires prompt recognition and treatment.
- Ludwig's angina: This is a severe infection of the submandibular space that can cause trismus, difficulty swallowing, and a muffled voice. It is a medical emergency due to the risk of airway obstruction.
- Cancer (e.g., oropharyngeal or hypopharyngeal): While less likely in the acute setting, a painful lymph node and asymmetric oropharynx could be signs of an underlying malignancy, which would require prompt evaluation and treatment.
- Rare diagnoses
- Actinomycosis: A rare bacterial infection that can cause abscesses and masses in the neck and jaw, potentially leading to trismus and a muffled voice.
- Histoplasmosis or other fungal infections: In immunocompromised patients, fungal infections can cause similar symptoms, including a thick white coating on the tongue and painful lymph nodes.
- Lemierre's syndrome: A rare condition characterized by a bacterial infection of the tonsils and subsequent thrombophlebitis of the internal jugular vein, which can cause a painful lymph node and difficulty swallowing.