Differential Diagnosis

The patient's symptoms of fever, nausea, vomiting, and a history of similar symptoms with strep throat suggest several possible diagnoses. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Acute Pharyngitis (Strep Throat): The patient's symptoms, including a high fever and a history of similar episodes diagnosed as strep throat, make this the most likely diagnosis. The patient's ability to tolerate fluids and the absence of other alarming symptoms also support this diagnosis.
• Other Likely diagnoses
  • Viral Pharyngitis: Many viruses can cause pharyngitis with symptoms similar to strep throat, including fever and nausea. The fact that the patient is able to tolerate fluids suggests a viral etiology could be possible.
  • Influenza: Given the acute onset of high fever, nausea, and vomiting, influenza should be considered, especially during flu season.
  • Mononucleosis: Although less common, mononucleosis (mono) caused by Epstein-Barr virus can present with fever, sore throat, and nausea, especially in young adults.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Epiglottitis: This is a life-threatening condition that can cause severe sore throat, fever, and difficulty swallowing. Although rare, it requires immediate medical attention.
  • Peritonsillar Abscess: A complication of tonsillitis, it can cause severe throat pain, fever, and difficulty swallowing. Prompt diagnosis and treatment are necessary to prevent serious complications.
  • Meningitis: Although the patient's symptoms do not strongly suggest meningitis, any patient with a high fever and signs of illness should be evaluated for this potentially deadly condition, especially if there are signs of neurological involvement.
• Rare diagnoses
  • Lemierre's Syndrome: A rare condition characterized by a bacterial infection of the throat, followed by sepsis and thrombophlebitis of the internal jugular vein. It's more common in young adults and can present with fever, sore throat, and systemic symptoms.
  • Diphtheria: A bacterial infection affecting the mucous membranes of the throat and nose. Although rare in developed countries due to vaccination, it should be considered in unvaccinated individuals or those traveling from areas where diphtheria is common.