Differential Diagnosis for a 12yo Female with Fever and Sore Throat

Single Most Likely Diagnosis

• Viral Pharyngitis: This is the most common cause of sore throat and fever in children, often caused by viruses such as adenovirus, rhinovirus, or coronavirus. The justification for this diagnosis is the high prevalence of viral infections in the pediatric population and the typical presentation of fever and sore throat.

Other Likely Diagnoses

• Streptococcal Pharyngitis: Caused by Group A beta-hemolytic streptococcus (GABHS), this bacterial infection is a common cause of sore throat in children and can be differentiated from viral pharyngitis through clinical evaluation and rapid streptococcal antigen testing.
• Infectious Mononucleosis: Caused by Epstein-Barr virus (EBV), this condition can present with fever, sore throat, and lymphadenopathy, especially in adolescents.
• Tonsillitis: Inflammation of the tonsils, which can be caused by either viral or bacterial pathogens, leading to symptoms of sore throat, fever, and difficulty swallowing.

Do Not Miss Diagnoses

• Lemierre's Syndrome: A rare but potentially life-threatening condition caused by Fusobacterium necrophorum, characterized by sore throat, fever, and neck pain, which can progress to sepsis and jugular vein thrombosis if not promptly treated.
• Retropharyngeal Abscess: A serious infection in the tissues at the back of the throat, which can cause severe sore throat, fever, and difficulty swallowing, and may lead to airway obstruction if not treated urgently.
• Epiglottitis: Inflammation of the epiglottis, which can be life-threatening due to the risk of airway obstruction. Although more common in younger children, it should be considered in any child with severe sore throat and fever.

Rare Diagnoses

• Diphtheria: A bacterial infection caused by Corynebacterium diphtheriae, characterized by a membrane covering the tonsils and throat, which is rare in areas with high vaccination coverage but can be seen in unvaccinated or under-vaccinated populations.
• Peritonsillar Abscess: A collection of pus behind the tonsils, which can cause severe sore throat, fever, and difficulty swallowing, and is a complication of tonsillitis.
• Tuberculous Pharyngitis: A rare form of tuberculosis that affects the pharynx, which can present with chronic sore throat, fever, and weight loss, especially in immunocompromised individuals or those from areas with high TB prevalence.