Differential Diagnosis

• Single most likely diagnosis
  • Oral thrush (candidiasis): The patient's symptoms of a bad taste in the mouth, mild pain on the tongue, and white spots are consistent with oral thrush, a common fungal infection. The fact that mouthwash made it worse could be due to the alcohol content in the mouthwash irritating the oral mucosa.
• Other Likely diagnoses
  • Geographic tongue: This condition is characterized by the appearance of white or red patches on the tongue, which could cause a bad taste and mild pain. However, it doesn't fully explain the worsening with mouthwash.
  • Lichen planus: An autoimmune condition that can cause white patches and pain in the mouth, but it's less likely given the acute onset and resolution of the sore throat.
  • Oral leukoplakia: A condition characterized by white patches in the mouth, but it's often associated with chronic irritation, such as from tobacco use, and doesn't fully explain the patient's symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Oral cancer: Although unlikely, oral cancer can present with white patches, pain, and a bad taste in the mouth. It's essential to consider this diagnosis, especially if the patient has a history of tobacco or alcohol use.
  • Infectious mononucleosis: The patient's recent sore throat could be related to infectious mononucleosis, which can cause oral ulcers and a bad taste in the mouth.
  • HIV-related oral lesions: Certain oral lesions, such as oral hairy leukoplakia, can be associated with HIV infection. Although unlikely, it's crucial to consider this diagnosis, especially if the patient is at high risk.
• Rare diagnoses
  • Pemphigus vulgaris: A rare autoimmune condition that can cause oral blisters and ulcers, but it's less likely given the patient's symptoms and the absence of skin lesions.
  • Oral psoriasis: A rare condition that can cause white patches and pain in the mouth, but it's often associated with skin lesions and other systemic symptoms.