Differential Diagnosis
- Single Most Likely Diagnosis
- Infectious Mononucleosis (Mono): This diagnosis is likely due to the combination of swollen tonsils, intermittent fever, lethargy, sore throat, and headaches in all family members. The pinprick rash in the children and ulcers on the genitals of the adult could be related to a viral infection, and mono can sometimes present with a rash, especially after taking certain antibiotics.
- Other Likely Diagnoses
- Group A Streptococcal Infection: This could explain the sore throat and swollen tonsils, and the rash could be a manifestation of Scarlet Fever, a complication of streptococcal infection.
- Viral Pharyngitis: Many viruses can cause pharyngitis, and some, like enteroviruses, can cause rashes.
- Influenza: Although less likely given the specific constellation of symptoms, influenza can cause fever, lethargy, headaches, and sore throat, and sometimes a rash.
- Do Not Miss Diagnoses
- Meningitis: Although the symptoms do not strongly suggest meningitis, the presence of fever, headache, and lethargy necessitates consideration of this potentially life-threatening condition.
- Sepsis: Any infection that causes fever, lethargy, and systemic symptoms like rash or ulcers could potentially lead to sepsis, a life-threatening condition.
- HIV Infection: Acute HIV infection can present with fever, rash, sore throat, and systemic symptoms, making it a critical diagnosis not to miss, especially in the adult with genital ulcers.
- Rare Diagnoses
- Kawasaki Disease: This condition, which mainly affects children, can cause fever, rash, and swollen lymph nodes, but it's less likely given the adult's symptoms.
- Toxic Shock Syndrome: Although rare, this condition can cause fever, rash, and systemic symptoms, and the presence of ulcers in the adult could be a sign of a staphylococcal or streptococcal infection leading to toxic shock.
- Leptospirosis: This bacterial infection can cause a wide range of symptoms including fever, headache, and rash, but it's less common and typically associated with exposure to contaminated water.