Differential Diagnosis for a 21-year-old Female with Sore Throat and Associated Symptoms
Single most likely diagnosis
- Viral Pharyngitis: Given the symptoms of sore throat, red spots and swelling in the back part of the tongue, congestion, cough, and a pink and painful left eye, along with negative rapid strep, COVID, and flu tests, viral pharyngitis is the most likely diagnosis. The presence of these symptoms without a positive test for common bacterial or viral causes points towards a viral etiology.
Other Likely diagnoses
- Mononucleosis (Mono): Although the patient has had a tonsillectomy, mono can still occur and cause sore throat, fever, and fatigue. The swollen lymph nodes and sore throat could be indicative of this condition.
- Adenoviral Pharyngoconjunctival Fever: This condition is characterized by pharyngitis, conjunctivitis (which could explain the pink and painful eye), and fever, making it a plausible diagnosis given the patient's symptoms.
- Herpangina: This viral infection causes small, painful blisters or ulcers on the roof of the mouth and the back of the throat, which could be described as red spots and swelling in the back part of the tongue.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Lemierre's Syndrome: A rare but serious condition that starts with pharyngitis and can progress to sepsis and jugular vein thrombosis. Early recognition is crucial.
- Epiglottitis: Although rare in adults, epiglottitis can cause severe respiratory distress and requires immediate medical attention. The symptoms of sore throat and cough could be initial presentations.
- Peritonsillar Abscess: Despite the patient having had a tonsillectomy, there's a small chance of abscess formation in the remaining tissue, which would require prompt drainage.
Rare diagnoses
- Diphtheria: A bacterial infection that can cause a sore throat and a membrane to form in the throat, although it's very rare in areas with high vaccination rates.
- Streptococcal Toxic Shock Syndrome: A severe condition that can arise from streptococcal infections, characterized by severe pain, fever, and rash, which could be life-threatening if not recognized early. The negative rapid strep test does not entirely rule out a streptococcal infection, as sensitivity can vary.