Differential Diagnosis for Sore Throat and Neck Tenderness

The patient presents with soreness on one side of the throat, difficulty swallowing, and tenderness to touch on the same side of the neck, accompanied by fluid in the ear on the affected side. These symptoms appeared after taking a blood pressure pill the previous night. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Angioedema: This condition is characterized by the rapid swelling of the dermis, subcutaneous tissue, mucosa, and submucosal tissues. It can be caused by an allergic reaction, which might be related to the blood pressure medication taken. Symptoms include swelling, which could lead to soreness and difficulty swallowing, and it can also cause neck tenderness. The fluid in the ear could be related to Eustachian tube dysfunction due to swelling.
• Other Likely Diagnoses
  • Peritonsillar Abscess: An accumulation of pus behind the tonsils that can cause severe throat pain, usually on one side, difficulty swallowing, and fever. The tenderness in the neck could be due to lymphadenopathy.
  • Tonsillitis: Inflammation of the tonsils, which can be caused by viral or bacterial infections. Symptoms include sore throat, difficulty swallowing, and fever. The neck tenderness could be from lymph node enlargement.
  • Lymphadenitis: Inflammation of the lymph nodes in the neck, which can cause neck pain and tenderness, and is often accompanied by other symptoms like fever and sore throat.
• Do Not Miss Diagnoses
  • Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE): Although less likely, these conditions can present with sudden onset of symptoms and can be life-threatening. The swelling and pain could theoretically be related to a DVT, though this is less common in the context provided.
  • Lemierre's Syndrome: A rare but serious condition characterized by a bacterial infection of the throat, followed by thrombophlebitis of the internal jugular vein and metastatic infections. It presents with severe sore throat, high fever, and neck pain.
• Rare Diagnoses
  • Temporal Arteritis or Giant Cell Arteritis: Although more common in older adults, this condition can cause jaw claudication, visual disturbances, and sometimes sore throat or neck pain due to the involvement of the arteries supplying these areas.
  • Neck or Throat Cancer: Though rare and less likely without a history of progressive symptoms, cancer can cause sore throat, difficulty swallowing, and neck masses.

Given the acute onset after taking medication, Angioedema is a strong consideration due to its potential for an allergic reaction to the medication. However, each diagnosis should be considered based on a thorough history, physical examination, and appropriate diagnostic tests to rule out life-threatening conditions.