Differential Diagnosis

The patient's symptoms of headache, sore throat, and tender swelling over the right side of the neck, along with a history of tonsillitis since childhood and tonsillar enlargement, suggest several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis
  • Peritonsillar Abscess: This condition is a complication of tonsillitis where an abscess forms beside the tonsils. It is characterized by severe throat pain, fever, swollen and tender lymph nodes in the neck, and difficulty swallowing. The patient's history and symptoms align closely with this diagnosis.
• Other Likely Diagnoses
  • Tonsillitis: Given the patient's history of tonsillitis since childhood, a current episode of tonsillitis could explain the symptoms. Tonsillitis can cause sore throat, fever, and swollen lymph nodes.
  • Lymphadenitis: Inflammation of the lymph nodes in the neck, which can be caused by a bacterial or viral infection, could explain the tender swelling on the right side of the neck.
  • Mononucleosis (Mono): Caused by the Epstein-Barr virus, mono can lead to sore throat, fever, swollen lymph nodes, and tonsillar enlargement, especially in younger patients.
• Do Not Miss Diagnoses
  • Lemierre's Syndrome: A rare but serious condition that starts with a sore throat and can progress to a life-threatening infection of the jugular vein. It's essential to consider this diagnosis due to its potential severity.
  • Retropharyngeal Abscess: Although less common, this condition involves an abscess in the tissues in the back of the throat and can cause severe symptoms, including difficulty swallowing and breathing.
• Rare Diagnoses
  • Tuberculous Tonsillitis: A rare form of tonsillitis caused by Mycobacterium tuberculosis. It could present with chronic symptoms and should be considered in endemic areas or in patients with risk factors for tuberculosis.
  • Malignancy (e.g., Lymphoma): Although rare, lymphoma or other malignancies could cause persistent or recurrent swelling of the lymph nodes and tonsillar enlargement. This diagnosis would be considered if other causes are ruled out and symptoms persist or worsen over time.

Treatment (Rx)

The treatment will depend on the final diagnosis:

• Peritonsillar Abscess: Requires drainage of the abscess, usually through a procedure called needle aspiration, and antibiotics.
• Tonsillitis: Treatment depends on whether the cause is viral or bacterial. Viral tonsillitis is managed symptomatically, while bacterial tonsillitis is treated with antibiotics.
• Lymphadenitis: Treatment is aimed at the underlying cause, which could include antibiotics for bacterial infections.
• Mononucleosis: Primarily managed symptomatically, with rest, hydration, and pain management.
• Lemierre's Syndrome and Retropharyngeal Abscess: Require immediate medical attention, including antibiotics and possibly surgical intervention.
• Tuberculous Tonsillitis and Malignancy: Treatment would involve antitubercular therapy for tuberculosis and appropriate oncologic management for malignancies, respectively.