Differential Diagnosis for Abdominal Pain in the Context of Strep Throat

Single Most Likely Diagnosis

• Viral gastroenteritis: This is a common condition that can cause abdominal pain and is often seen in conjunction with or following a viral infection like strep throat. The symptoms can overlap, and the abdominal pain might be attributed to the viral infection itself or to a secondary viral gastroenteritis.

Other Likely Diagnoses

• Mesenteric lymphadenitis: This condition involves inflammation of the lymph nodes in the mesentery (the tissue that attaches the intestines to the back of the abdominal wall) and can be caused by viral or bacterial infections, including strep throat. It presents with abdominal pain, often mimicking appendicitis.
• Constipation: Pain from constipation can sometimes be confused with other causes of abdominal pain. Given the potential for decreased fluid intake or altered bowel habits during an illness like strep throat, constipation is a plausible cause.
• Gastroesophageal reflux disease (GERD): Although not directly caused by strep throat, the discomfort and altered eating habits during an illness might exacerbate GERD symptoms, leading to abdominal pain.

Do Not Miss Diagnoses

• Appendicitis: Although less common, appendicitis is a critical diagnosis that must not be missed. It can present with abdominal pain and might be triggered by a viral or bacterial infection. The consequences of missing this diagnosis can be severe.
• Perforated viscus: Any condition that leads to a hole in the wall of the gastrointestinal tract can cause severe abdominal pain and is life-threatening. While rare, it's a diagnosis that cannot be overlooked.
• Intra-abdominal abscess: An abscess within the abdominal cavity can be a complication of an infection and requires prompt diagnosis and treatment to avoid serious consequences.

Rare Diagnoses

• Hemolytic uremic syndrome (HUS): Although more commonly associated with E. coli infections, HUS can rarely be triggered by other bacterial infections, including strep throat, especially in children. It leads to kidney failure and is characterized by abdominal pain among other symptoms.
• Streptococcal toxic shock syndrome: A rare but severe condition caused by streptococcal infections, including those that cause strep throat. It can present with abdominal pain among a constellation of other systemic symptoms.