Differential Diagnosis for a 25-year-old Female with Sore Throat and Associated Symptoms
- Single most likely diagnosis:
- Mononucleosis (Infectious Mononucleosis): This is likely due to the prolonged duration of symptoms, worsening condition despite negative strep tests, and the presence of systemic symptoms such as chills, body aches, and decreased appetite. The recent history of strep throat could be a red herring, and the symptoms are consistent with a viral etiology like Epstein-Barr virus.
- Other Likely diagnoses:
- Viral Pharyngitis: Given the negative strep tests and the presence of systemic symptoms, a viral cause is plausible. The symptoms of sore throat, chills, body aches, and decreased appetite are common in viral pharyngitis.
- Tonsillitis: Could be a complication or a separate entity from the initial strep throat, especially if the tonsils are inflamed and painful, contributing to the sore throat and difficulty sleeping.
- Sinusitis: The bilateral ear pain and neck pain could be referred pain from sinusitis, especially if there's an involvement of the Eustachian tube or sinus pressure radiating to the ears and neck.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Lemierre's Syndrome: Although rare, this condition involves a bacterial infection of the throat that spreads to the jugular vein, leading to thrombophlebitis. It's crucial to consider due to its high mortality rate if not treated promptly.
- Peritonsillar Abscess: A complication of tonsillitis that can lead to severe consequences, including airway obstruction, if not diagnosed and treated promptly.
- Epiglottitis: An inflammatory condition of the epiglottis that can lead to airway obstruction, which is a medical emergency.
- Rare diagnoses:
- Tuberculous Pharyngitis: Although rare in immunocompetent individuals, it could present with chronic sore throat and systemic symptoms.
- Sjögren's Syndrome: An autoimmune disorder that can cause chronic sore throat among other symptoms, but it's less likely given the acute presentation.
- HIV Pharyngitis: Primary HIV infection can present with sore throat and systemic symptoms, but it's less common and would require specific risk factors and further testing for diagnosis.