Differential Diagnosis

The patient presents with swollen tonsils, white spots or patches, neck lymphadenopathy, intermittent ear and head aches, and a history of a needle prick injury from an individual of unknown HIV status. The patient was also on Amoxicillin from 20/6/25 to 27/5/25, which seems to be a typographical error in dates, but we'll proceed with the understanding that the patient was recently on antibiotics.

• Single Most Likely Diagnosis

  • Acute Tonsillitis: This is likely given the symptoms of swollen tonsils with white spots or patches, which are classic for tonsillitis, often caused by streptococcal or viral infections. The recent use of Amoxicillin suggests a bacterial infection was suspected or treated.

• Other Likely Diagnoses

  • Viral Pharyngitis: Similar to tonsillitis but can be caused by a variety of viruses, leading to similar symptoms including sore throat, swollen lymph nodes, and possibly fever.
  • Mononucleosis (Infectious Mononucleosis): Caused by Epstein-Barr virus (EBV), it can present with sore throat, fever, swollen lymph nodes, and fatigue. The presence of white spots on the tonsils can also be seen in mononucleosis.
  • Streptococcal Pharyngitis: Although the patient was on Amoxicillin, if the treatment course was inadequate (either in duration or because the infection was resistant), this could still be a consideration.

• Do Not Miss Diagnoses

  • HIV Acute Retroviral Syndrome: Given the history of a needle prick injury from an individual of unknown HIV status, it's crucial to consider the possibility of HIV infection, especially if the patient is in the acute phase, which can present with flu-like symptoms, including sore throat, fever, and lymphadenopathy.
  • Lymphoma: Although less common, lymphoma can present with lymphadenopathy and systemic symptoms like fever and fatigue. It's a diagnosis that would be critical not to miss.
  • Tuberculosis (TB): TB can cause lymphadenopathy, fever, and systemic symptoms. Given the global prevalence of TB and its potential for severe consequences if untreated, it's a diagnosis that should be considered, especially in high-risk populations.

• Rare Diagnoses

  • Lemierre's Syndrome: A rare condition characterized by a bacterial infection of the tonsils followed by septic thrombophlebitis of the internal jugular vein, which can present with neck pain, swelling, and lymphadenopathy.
  • Diphtheria: Although rare in areas with good vaccination coverage, diphtheria can cause a severe sore throat with a membrane covering the tonsils and throat, and it can lead to serious complications if not treated promptly.
  • Toxoplasmosis: In immunocompromised individuals, toxoplasmosis can cause lymphadenopathy and systemic symptoms. Given the potential needle prick exposure to HIV, if the patient is immunocompromised, this could be a consideration.