Differential Diagnosis for 60-year-old Female with Left-Sided Sore Throat
Single Most Likely Diagnosis
- Viral Pharyngitis: Given the patient's recent history of cold-like symptoms and the presentation of a sore throat without fever, cough, or shortness of breath, viral pharyngitis is the most likely diagnosis. The radiation of pain to the ear is also consistent with this condition.
Other Likely Diagnoses
- Streptococcal Pharyngitis: Although the patient denies fever, streptococcal pharyngitis (strep throat) is a common cause of sore throat and should be considered, especially if the patient has been exposed to someone with strep throat. The absence of cough and nasal congestion does not rule out this diagnosis.
- Acute Otitis Media: The radiation of pain to the left ear could suggest an ear infection, which can occur concurrently with or as a complication of pharyngitis.
- Acute Tonsillitis: If the patient has tonsils, acute tonsillitis could be a consideration, especially if the sore throat is severe and localized to one side.
Do Not Miss Diagnoses
- Lemierre's Syndrome: A rare but potentially life-threatening condition that starts with pharyngitis and can progress to septic thrombophlebitis of the internal jugular vein. It's crucial to consider this in patients with severe or persistent sore throat.
- Peritonsillar Abscess: Although less likely without significant tonsillar swelling or severe pain, a peritonsillar abscess is a serious condition that requires prompt diagnosis and treatment.
- Epiglottitis: While more commonly associated with severe sore throat, difficulty swallowing, and shortness of breath, epiglottitis can present atypically and is a medical emergency.
Rare Diagnoses
- Tuberculous Pharyngitis: In patients with risk factors for tuberculosis (TB), such as immunocompromised states or exposure history, TB pharyngitis could be considered, although it is rare.
- Syphilitic Pharyngitis: Primary syphilis can cause a sore throat, and although rare, it should be considered in patients with risk factors for sexually transmitted infections.
- Malignancy: In older adults, persistent or severe sore throat can rarely be the first symptom of head and neck cancers, such as oropharyngeal or hypopharyngeal cancer.