Differential Diagnosis for a 44-year-old Female with Sore Throat and Fever
- Single most likely diagnosis:
- Streptococcal Pharyngitis: This is the most likely diagnosis given the symptoms of sore throat, fever, anterior cervical swelling and tenderness, and a white patch on the tonsil. The presence of a white patch (exudate) and the acute onset of symptoms are consistent with streptococcal pharyngitis.
- Other Likely diagnoses:
- Viral Pharyngitis: Although the presence of a white patch on the tonsil might lean more towards a bacterial cause, viral pharyngitis is very common and can present with similar symptoms, including fever and sore throat. The absence of cough and other respiratory symptoms might make this less likely but still a consideration.
- Mononucleosis (Infectious Mononucleosis): Caused by Epstein-Barr virus, this condition can present with sore throat, fever, and lymphadenopathy (which could explain the anterior cervical swelling). The white patch on the tonsil could also be consistent with this diagnosis, especially if the patient is young and has other systemic symptoms like fatigue.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Lemierre's Syndrome: A rare but potentially life-threatening condition that starts with pharyngitis and progresses to septicemia and thrombophlebitis of the internal jugular vein. The presence of severe neck pain, swelling, and fever should raise suspicion for this condition.
- Peritonsillar Abscess: Although the patient mentions a white patch on one tonsil, which could be exudate from streptococcal pharyngitis, the possibility of a peritonsillar abscess (a collection of pus behind the tonsil) should be considered, especially if there's significant swelling and pain localized to one side.
- Epiglottitis: An inflammation of the epiglottis that can cause severe sore throat, difficulty swallowing, and in severe cases, airway obstruction. This condition is less common in adults but can be life-threatening if not recognized promptly.
- Rare diagnoses:
- Diphtheria: A bacterial infection that can cause a sore throat and a white patch on the tonsils, but it's very rare in developed countries due to vaccination.
- Tuberculous Pharyngitis: Although rare, tuberculosis can affect the pharynx and present with chronic sore throat, fever, and weight loss. This diagnosis would be considered in patients with risk factors for tuberculosis.