Differential Diagnosis for 18-year-old Male with Right Tonsil Hypertrophy and Sore Throat

• Single Most Likely Diagnosis
  • Peritonsillar abscess: This condition is characterized by a collection of pus behind the tonsil, often presenting with severe sore throat, tonsil hypertrophy, and sometimes deviation of the uvula. The absence of cough or fever does not rule out this diagnosis, as some patients may not exhibit all typical symptoms.
• Other Likely Diagnoses
  • Tonsillitis (viral or bacterial): Although the patient does not have a fever, tonsillitis can present with sore throat and tonsil hypertrophy. The lack of cough might suggest a bacterial cause, but viral etiologies should also be considered.
  • Mononucleosis (infectious mononucleosis): Caused by Epstein-Barr virus, this condition can lead to sore throat, fever (though not always present), and tonsillar hypertrophy. The diagnosis might be considered, especially if the patient has other symptoms like fatigue or lymphadenopathy.
• Do Not Miss Diagnoses
  • Malignancy (e.g., lymphoma): Although rare in young adults, malignancies such as lymphoma can present with asymmetric tonsil hypertrophy and sore throat. It's crucial to consider this diagnosis to ensure timely intervention if present.
  • Lemierre's syndrome: A rare but serious condition characterized by a bacterial infection of the tonsils that spreads to the jugular vein, causing thrombophlebitis. It typically presents with sore throat, fever, and neck pain, but the initial presentation can be atypical.
• Rare Diagnoses
  • Tuberculosis: Although rare in many parts of the world, tuberculosis can affect the tonsils, presenting with chronic sore throat, tonsil hypertrophy, and systemic symptoms like weight loss and night sweats.
  • Sarcoidosis: A systemic granulomatous disease that can rarely involve the tonsils, leading to hypertrophy and sore throat, among other symptoms like cough, shortness of breath, and skin lesions.
  • Kikuchi-Fujimoto disease: A rare, self-limiting condition that can cause lymphadenopathy and might involve the tonsils, presenting with sore throat and fever, though it's more commonly associated with cervical lymphadenopathy.