Differential Diagnosis for Sore Throat

Given the symptoms of a sore throat for 3 weeks, pain with yawning and swallowing, intermittent subjective fevers, and no relief with ibuprofen, along with a negative definitive throat culture, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Mononucleosis (Infectious Mononucleosis): This condition, caused by Epstein-Barr virus (EBV), is characterized by a prolonged sore throat, fever, and fatigue. The absence of relief with ibuprofen and the duration of symptoms align with this diagnosis. A negative throat culture does not rule out mononucleosis, as it is typically diagnosed through serologic tests.

• Other Likely Diagnoses

  • Streptococcal Pharyngitis (with a false-negative culture): Although the throat culture is negative, streptococcal pharyngitis cannot be entirely ruled out, especially if the culture was not performed correctly or if the patient was on antibiotics recently. Repeated testing or clinical judgment may be necessary.
  • Viral Pharyngitis: Various viruses can cause prolonged sore throat, and the absence of bacterial growth on culture, along with the clinical presentation, supports this diagnosis.
  • Acid Reflux (Gastroesophageal Reflux Disease, GERD): GERD can cause chronic sore throat due to acid reflux, which might not respond to typical pain relievers like ibuprofen.

• Do Not Miss Diagnoses

  • Lemierre's Syndrome: A rare but potentially life-threatening condition characterized by a sore throat followed by neck pain and fever, due to a bacterial infection (usually Fusobacterium necrophorum) that can lead to sepsis and jugular vein thrombosis.
  • Epiglottitis: An acute inflammation of the epiglottis that can cause severe sore throat, difficulty swallowing, and fever. It is a medical emergency due to the risk of airway obstruction.
  • Tuberculosis (TB): Although less common, TB can present with chronic sore throat, fever, and weight loss. It's crucial to consider TB, especially in high-risk populations or areas with high TB prevalence.
  • HIV Infection: Initial presentation of HIV can include a prolonged sore throat among other symptoms, making it a critical diagnosis not to miss due to its implications for long-term health and transmission.

• Rare Diagnoses

  • Sarcoidosis: A systemic disease that can cause granulomatous inflammation in various parts of the body, including the throat, leading to chronic sore throat.
  • Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): A rare autoimmune disorder that can affect the respiratory tract and present with chronic sore throat among other symptoms.
  • Tongue or Throat Cancer: Although rare, especially in younger populations, cancer should be considered in the differential diagnosis of a chronic sore throat, particularly if there are risk factors such as smoking or a family history of cancer.