Differential Diagnosis for a Prior Alcoholic Patient with Smoking History Presenting with Pharyngitis

Single Most Likely Diagnosis

• Viral Pharyngitis: Given the patient's presentation, viral pharyngitis is the most likely diagnosis. It is a common condition that can be caused by various viruses, and its symptoms can include sore throat, fever, and difficulty swallowing. The patient's history of smoking and alcohol use may compromise their immune system, making them more susceptible to viral infections.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): The patient's symptoms could also be consistent with GERD, especially given their history of alcohol use, which can exacerbate reflux symptoms. GERD can cause symptoms similar to pharyngitis, including a sore throat and difficulty swallowing.
• Bacterial Pharyngitis: Although less common than viral pharyngitis, bacterial causes (such as streptococcal pharyngitis) should be considered, especially if the patient presents with severe symptoms or if viral pharyngitis is not responding to supportive care.

Do Not Miss Diagnoses

• Esophageal Cancer: Given the patient's history of smoking and alcohol use, there is an increased risk of esophageal cancer. Although it is less likely, it is crucial not to miss this diagnosis due to its severe prognosis if left untreated. Symptoms can include difficulty swallowing, weight loss, and persistent sore throat.
• Peptic Ulcer Disease: The patient's history of alcohol use and potential use of NSAIDs for pain relief increases the risk of peptic ulcer disease. Bleeding from a peptic ulcer can be life-threatening and requires immediate medical attention.

Rare Diagnoses

• Lemierre's Syndrome: A rare but serious condition that occurs when a bacterial infection, typically caused by Fusobacterium necrophorum, spreads from the throat to the bloodstream and lymph nodes. It can cause severe symptoms, including high fever, swollen lymph nodes, and respiratory distress.
• Tuberculosis (TB): Although rare in some populations, TB can cause pharyngitis and should be considered, especially if the patient has been exposed to TB or has risk factors such as immunocompromised status.

Regarding the use of NSAIDs for viral pharyngitis, while they can provide relief for pain and inflammation, their use should be cautious in patients with a history of alcohol use and smoking due to the increased risk of gastrointestinal bleeding. Alternative pain management strategies, such as acetaminophen, may be considered initially. However, the decision to use NSAIDs should be made on a case-by-case basis, weighing the benefits against the potential risks.