Sore Throat Pain Differential Diagnosis

The differential diagnosis for sore throat pain can be categorized into several groups based on likelihood and potential impact of missing the diagnosis.

• Single Most Likely Diagnosis

  • Viral pharyngitis: This is the most common cause of sore throat, often associated with other symptoms like cough, runny nose, and fever. It's usually self-limiting and caused by viruses such as rhinovirus, coronavirus, adenovirus, and others.

• Other Likely Diagnoses

  • Bacterial pharyngitis (Streptococcal pharyngitis): Caused by Group A beta-hemolytic streptococcus, it presents with severe sore throat, fever, and sometimes exudates on the tonsils. It's less common than viral pharyngitis but requires antibiotic treatment to prevent complications.
  • Tonsillitis: Inflammation of the tonsils, which can be caused by both viral and bacterial pathogens. Symptoms include sore throat, difficulty swallowing, and fever.
  • Laryngitis: Inflammation of the larynx, often resulting from viral infections or voice strain, leading to hoarseness and sore throat.

• Do Not Miss Diagnoses

  • Epiglottitis: A potentially life-threatening condition where the epiglottis becomes inflamed, which can lead to airway obstruction. It's more common in children but can occur in adults, especially those with compromised immune systems.
  • Peritonsillar abscess: A collection of pus behind the tonsil that can cause severe throat pain, difficulty swallowing, and fever. If not treated promptly, it can lead to airway obstruction or abscess rupture.
  • Lemierre's syndrome: A rare but serious condition following a bacterial pharyngitis infection, characterized by thrombophlebitis of the internal jugular vein and metastatic infections.
  • Retropharyngeal abscess: An abscess in the tissues in the back of the throat, which can cause sore throat, neck stiffness, and difficulty swallowing, and can lead to airway obstruction if not treated.

• Rare Diagnoses

  • Diphtheria: A bacterial infection affecting the mucous membranes of the throat and nose, though rare in areas with widespread vaccination. It can cause a sore throat and a distinctive greyish membrane covering the tonsils and throat.
  • Infectious mononucleosis (Mono): Caused by the Epstein-Barr virus, it can lead to sore throat, fever, and lymphadenopathy. While not typically considered rare, it's less common than other viral causes of sore throat.
  • Gonococcal pharyngitis: A sexually transmitted infection caused by Neisseria gonorrhoeae, which can result in sore throat, often without other symptoms.
  • Tuberculous pharyngitis: A rare form of tuberculosis that affects the pharynx, more common in immunocompromised individuals or in areas with high TB prevalence.