Differential Diagnosis for a 14-year-old Male with Sore Throat and Fever
- Single most likely diagnosis:
- Viral Pharyngitis: This is the most common cause of sore throat in children and adolescents, often associated with fever. The lack of nasal congestion, rhinorrhea, or cough, and the failure to respond to over-the-counter medications, does not rule out viral pharyngitis, as these symptoms can vary.
- Other Likely diagnoses:
- Streptococcal Pharyngitis (Strep Throat): A common bacterial infection that presents with sore throat and fever. It's a key consideration given the acute onset and the presence of fever.
- Mononucleosis (Infectious Mononucleosis): Caused by Epstein-Barr virus, it can present with sore throat, fever, and fatigue. Although it's more common in slightly older teenagers, it should be considered, especially if the sore throat is severe and accompanied by significant fatigue or lymphadenopathy.
- 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 septicemia and thrombophlebitis of the internal jugular vein. It's crucial to consider in cases of severe or persistent sore throat.
- Peritonsillar Abscess: A complication of tonsillitis that can cause severe throat pain, fever, and difficulty swallowing. It requires prompt medical attention.
- Retropharyngeal Abscess: Although more common in younger children, it can occur in adolescents and presents with sore throat, fever, and neck stiffness.
- Rare diagnoses:
- Diphtheria: A bacterial infection that can cause a severe sore throat, although it's rare in areas with high vaccination coverage.
- Gonococcal Pharyngitis: A sexually transmitted infection that can cause sore throat, more relevant if there's a history of sexual activity.
- Tularemia: A rare bacterial infection that can cause pharyngitis among other symptoms, typically associated with exposure to infected animals or contaminated water.