Differential Diagnosis for a 16-year-old Female with Positive Strep Throat, Neck Swelling, and Pain with Opening of the Mouth
- Single most likely diagnosis:
- Peritonsillar abscess: This condition is a common complication of strep throat, especially in adolescents. The symptoms of neck swelling and pain with opening the mouth (trismus) are classic for a peritonsillar abscess, which is a collection of pus behind the tonsils.
- Other Likely diagnoses:
- Lymphadenitis: Infection of the lymph nodes in the neck can cause swelling and pain, especially if associated with a streptococcal infection. The pain with opening the mouth could be due to inflammation of the lymph nodes near the jaw.
- Tonsillitis: Although the primary symptom of tonsillitis is sore throat, severe cases can lead to significant swelling and discomfort that might limit mouth opening.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Retropharyngeal abscess: This is a serious infection in the space at the back of the throat. It can cause severe swelling, pain with swallowing or opening the mouth, and can lead to airway obstruction if not promptly treated.
- Lemierre's syndrome: A rare but potentially life-threatening condition that starts with a sore throat and can progress to include neck swelling due to thrombophlebitis of the internal jugular vein. It's crucial to consider this diagnosis due to its high morbidity and mortality if not treated appropriately.
- Rare diagnoses:
- Tuberculous lymphadenitis: Although less common in developed countries, tuberculosis can cause lymph node swelling in the neck, which might be accompanied by systemic symptoms like fever and weight loss.
- Neck cysts or tumors: These could cause swelling and, depending on their location, might lead to discomfort or pain with certain movements, including opening the mouth. However, they would be less likely to be directly associated with a positive strep throat test.