Differential Diagnosis for Sore Throat with Bleeding

Single Most Likely Diagnosis

• Tonsillitis: This is often the first consideration for sore throat with bleeding, especially if the bleeding is from the tonsils. Tonsillitis can be caused by viral or bacterial infections, with group A beta-hemolytic streptococcus being a common bacterial cause. The presence of bleeding may indicate a more severe infection or a complication such as a peritonsillar abscess.

Other Likely Diagnoses

• Pharyngitis: Similar to tonsillitis, pharyngitis (inflammation of the pharynx) can cause a sore throat and, in some cases, bleeding, especially if the cause is bacterial or if there is an ulceration.
• Oral Trauma: Accidental biting of the tongue, cheek, or throat, or any other form of oral trauma, can cause bleeding and soreness in the throat area.
• Gastroesophageal Reflux Disease (GERD): GERD can lead to stomach acid flowing up into the throat, causing irritation, soreness, and potentially bleeding, especially if there is an associated esophagitis.

Do Not Miss Diagnoses

• Cancer of the Throat or Tongue: Although less common, cancers in the throat or oral cavity can present with sore throat and bleeding. Early detection is crucial for effective treatment, making this a critical diagnosis not to miss.
• Epiglottitis: This is an inflammation of the epiglottis that can cause severe sore throat, difficulty swallowing, and potentially life-threatening airway obstruction. Bleeding can occur, especially if there is an ulceration or if the condition progresses.
• Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) in the Context of a Malignancy: In rare cases, a sore throat with bleeding could be a symptom of a malignancy that has led to a DVT or PE, especially if there are other systemic symptoms.

Rare Diagnoses

• Blood Disorders (e.g., Hemophilia, Thrombocytopenia): Certain blood disorders can increase the risk of bleeding, including in the throat, even with minor trauma or inflammation.
• Infectious Mononucleosis (Mono): Caused by the Epstein-Barr virus, mono can lead to severe sore throat and, in some cases, bleeding, especially if there is significant lymphoid hyperplasia or if the spleen is involved.
• Diphtheria: A bacterial infection that can cause a sore throat and, in severe cases, bleeding due to the formation of a pseudomembrane in the throat.
• Leukemia: Certain types of leukemia can cause bleeding and sore throat due to bone marrow suppression and thrombocytopenia.