Differential Diagnosis for a 19-year-old female with sore throat, cough, and fever of 104
Single Most Likely Diagnosis
- Mononucleosis (Infectious Mononucleosis): This condition, caused by the Epstein-Barr virus (EBV), is common in young adults and presents with sore throat, fever, and fatigue. The high fever and combination of symptoms make it a leading consideration.
Other Likely Diagnoses
- Streptococcal Pharyngitis: Although the presence of a cough might be less typical, streptococcal infections can cause high fevers and severe sore throats. It's a common condition in this age group and should be considered, especially with a negative COVID and flu test.
- Pneumonia: Given the cough and high fever, pneumonia (bacterial or viral, excluding COVID and flu due to negative tests) is a plausible diagnosis. It could be caused by other pathogens such as Mycoplasma pneumoniae, which is common in young adults.
- Acute Bronchitis: This condition could explain the cough and fever, especially if the patient has been exposed to respiratory pathogens other than COVID and flu.
Do Not Miss Diagnoses
- Lemierre's Syndrome: A rare but potentially life-threatening condition that starts with a sore throat and can progress to include high fever and respiratory symptoms. It's caused by Fusobacterium necrophorum and can lead to severe complications if not treated promptly.
- Retropharyngeal Abscess: Although more common in children, this condition can occur in adults and presents with severe sore throat, difficulty swallowing, and high fever. It requires urgent medical attention due to the risk of airway obstruction.
- Epiglottitis: Another condition that can cause severe sore throat and high fever, epiglottitis is an inflammation of the epiglottis that can lead to airway obstruction. It's less common but critical to diagnose early.
Rare Diagnoses
- Tuberculosis (TB): While less likely, TB can present with chronic cough, fever, and other systemic symptoms. It's essential to consider in patients with risk factors for TB exposure or those who have been immunocompromised.
- Cytomegalovirus (CMV) Infection: Similar to mononucleosis, CMV can cause a mononucleosis-like syndrome with fever, sore throat, and fatigue, especially in immunocompromised individuals or those with specific risk factors.
- Toxoplasmosis: Although more commonly associated with neurological symptoms in immunocompromised patients, toxoplasmosis can occasionally present with fever and sore throat in immunocompetent individuals.