Differential Diagnosis for a 19-year-old female with sore throat, cough, and fever of 104
Single Most Likely Diagnosis
- Viral Pharyngitis: This is the most likely diagnosis given the symptoms of sore throat, cough, and fever, especially since COVID, flu, and strep tests are negative. Many viruses can cause these symptoms, and the high fever suggests a viral etiology.
Other Likely Diagnoses
- Mononucleosis (Mono): Caused by Epstein-Barr virus (EBV), mono can present with sore throat, fever, and cough, although it often includes other symptoms like fatigue and lymphadenopathy.
- Adenoviral Infection: Adenoviruses can cause a range of respiratory symptoms, including sore throat, cough, and fever, and are common in young adults.
- Pertussis (Whooping Cough): Although less common in vaccinated populations, pertussis can cause a persistent cough and may be accompanied by sore throat and fever, especially in the early stages.
Do Not Miss Diagnoses
- Lemierre's Syndrome: A rare but potentially life-threatening condition that starts with pharyngitis and can progress to septicemia and thrombophlebitis. It's crucial to consider this diagnosis due to its high morbidity and mortality if missed.
- Epiglottitis: Although more common in children, epiglottitis can occur in adults and is a medical emergency due to the risk of airway obstruction. Symptoms can include sore throat, fever, and cough, along with difficulty swallowing and shortness of breath.
- Pneumonia: Bacterial pneumonia can present with these symptoms and is a critical diagnosis not to miss due to the potential for severe complications, including sepsis and respiratory failure.
Rare Diagnoses
- Tuberculosis (TB): While less common in immunocompetent young adults, TB can cause chronic cough, fever, and sore throat. It's essential to consider TB in the differential, especially if the patient has been exposed or has risk factors.
- Cytomegalovirus (CMV) Infection: CMV can cause a mononucleosis-like syndrome, including sore throat, fever, and cough, particularly in immunocompromised individuals or those who are CMV seronegative.
- Toxoplasmosis: Although more commonly associated with neurological symptoms in immunocompromised patients, toxoplasmosis can cause a mononucleosis-like illness in immunocompetent individuals, including sore throat and fever.