Differential Diagnosis for Sore Scratchy Throat and Pain with Swallowing
Single Most Likely Diagnosis
- Viral Pharyngitis: This is the most common cause of a sore throat and is often accompanied by other symptoms such as cough, runny nose, and fever. The duration of two weeks could be consistent with a prolonged viral infection or a post-viral complication.
Other Likely Diagnoses
- Streptococcal Pharyngitis: Although less common than viral pharyngitis, streptococcal (strep) throat is a significant cause of sore throat, especially in children and young adults. It typically presents with a sudden onset of severe throat pain, fever, and swollen lymph nodes.
- Acid Reflux (Gastroesophageal Reflux Disease, GERD): GERD can cause throat irritation and pain, especially when stomach acid flows up into the throat. This could be a consideration, especially if symptoms worsen after eating or at night.
- Allergic Pharyngitis: Allergies can cause postnasal drip, leading to throat irritation and soreness. If the patient has a history of allergies, this could be a contributing factor.
- Tonsillitis: Inflammation of the tonsils can cause severe throat pain, fever, and difficulty swallowing. It can be viral or bacterial in origin.
Do Not Miss Diagnoses
- Epiglottitis: A potentially life-threatening condition that causes severe swelling of the epiglottis, which can lead to airway obstruction. Symptoms include severe throat pain, difficulty swallowing, and shortness of breath.
- Lemierre's Syndrome: A rare but serious condition that starts with a sore throat and can progress to include fever, swollen lymph nodes, and potentially life-threatening complications such as sepsis or thrombophlebitis.
- Cancer (e.g., Oropharyngeal or Hypopharyngeal Cancer): Although rare, persistent throat pain or difficulty swallowing can be symptoms of throat cancer, especially in individuals with risk factors such as smoking or a history of HPV infection.
- Diphtheria: A bacterial infection that can cause a severe sore throat, although it is rare in areas with high vaccination rates.
Rare Diagnoses
- Tuberculosis (TB): Can cause chronic throat pain and difficulty swallowing, especially in individuals with compromised immune systems or those from areas with high TB prevalence.
- Syphilis: In its secondary stage, syphilis can cause a sore throat among other systemic symptoms.
- Mononucleosis (Mono): Caused by the Epstein-Barr virus, mono can lead to severe throat pain, fever, and swollen lymph nodes, typically in adolescents and young adults.
- Fungal Infections (e.g., Candidiasis): More common in immunocompromised patients, fungal infections can cause throat pain and difficulty swallowing.