Differential Diagnosis

• Single most likely diagnosis
  • Tonsillar or oropharyngeal candidiasis: The presence of a pearly white thing at the extreme back and base of the tongue and behind the tonsil, along with a history of recent antibiotic use (Amoxicillin), suggests an opportunistic fungal infection, which is common in such scenarios.
• Other Likely diagnoses
  • Residual or recurrent tonsillitis: Given the recent history of swollen tonsils with white spots or patches and the current finding of a pearly white thing, which could also represent residual infection or debris.
  • Eustachian tube dysfunction: The cracking or popping sound on the left side while stimulating the Eustachian tube could indicate dysfunction, possibly related to the recent infection or another cause.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Lymphoma: Although the lymphadenopathy has significantly resolved, the initial presentation and the USG finding of subcentimeter lymphadenopathy on both sides of the neck warrant consideration of lymphoma, especially given the preserved hilum which can be seen in lymphoma.
  • Tuberculosis: The history of swollen tonsils and bilateral neck lymphadenopathy, even though resolving, could be suggestive of tuberculosis, especially in endemic areas or in individuals with risk factors.
• Rare diagnoses
  • Histoplasmosis or other fungal infections: These could present with similar symptoms, including lymphadenopathy and oral lesions, especially in immunocompromised individuals.
  • Sarcoidosis: Although rare, it could present with lymphadenopathy and might involve the tonsils or other parts of the head and neck, leading to symptoms like those described.