Differential Diagnosis
- Single most likely diagnosis
- Infected thyroglossal duct cyst: The acute onset of pain over the anterior surface of the neck, exacerbated by swallowing or sticking out his tongue, and tenderness in the midline over the trachea in the region of the thyroid isthmus are highly suggestive of an infected thyroglossal duct cyst. This condition is a congenital anomaly that can become infected, presenting with the symptoms described.
- Other Likely diagnoses
- Cat-scratch disease: Although the boy has scratches from a cat, the primary symptoms do not directly point towards cat-scratch disease, which typically presents with lymphadenopathy near the site of the scratch. However, it cannot be ruled out without further investigation.
- Tonsillitis: Could be considered due to the fever, chills, and cervical lymphadenopathy, but the specific location of the pain and tenderness over the thyroid isthmus makes it less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Infectious mononucleosis: Although less likely given the specific location of pain, infectious mononucleosis can cause severe complications if not diagnosed and managed properly. It typically presents with fever, sore throat, and lymphadenopathy, but the pain pattern described is not typical.
- Epiglottitis: This is a medical emergency that can present with severe throat pain, difficulty swallowing, and fever. Although the symptoms do not perfectly align, the potential for airway compromise makes it a "do not miss" diagnosis.
- Rare diagnoses
- Viral syndrome: While viral syndromes can cause a wide range of symptoms including fever and lymphadenopathy, the specific localization of pain and tenderness over the thyroid isthmus makes this a less likely diagnosis.
- Subacute thyroiditis: An inflammatory condition of the thyroid gland that can cause neck pain, fever, and malaise. It is less common in children and the clinical presentation would need to be further evaluated to consider this diagnosis.