Differential Diagnosis for a 72-year-old Male with Sudden Sore Throat
Single Most Likely Diagnosis
- Viral Pharyngitis: This is the most common cause of sore throat in adults. Given the patient's recent history of a cold and temporary improvement, a viral etiology is plausible. The recurrence of symptoms could be due to a secondary viral infection or a viral pharyngitis that was not fully resolved.
Other Likely Diagnoses
- Streptococcal Pharyngitis: Although less common than viral pharyngitis, streptococcal (strep) throat is a significant consideration, especially if the patient has been exposed to someone with strep throat or has a history of recurrent strep infections. The sudden onset of a sore throat after a period of improvement could suggest a bacterial superinfection.
- Postnasal Drip: This condition, often associated with allergies or a cold, can cause sore throat due to the constant drip of mucus from the back of the nose down into the throat, irritating it.
- Acid Reflux (Gastroesophageal Reflux Disease, GERD): GERD can cause stomach acid to flow up into the throat, leading to irritation and soreness, especially if the patient lies down after eating or has a large meal close to bedtime.
Do Not Miss Diagnoses
- Epiglottitis: Although rare, epiglottitis is a life-threatening condition that requires immediate medical attention. It can present with a severe sore throat, difficulty swallowing, and shortness of breath. The patient's age and sudden onset of symptoms make this a critical diagnosis not to miss.
- Lemierre's Syndrome: This is a rare but serious condition that starts with a sore throat and can progress to include high fever, swollen lymph nodes, and potentially life-threatening complications such as sepsis or thrombophlebitis.
- Peritonsillar Abscess: This condition, characterized by a collection of pus behind the tonsils, can cause severe throat pain, difficulty swallowing, and fever. It requires prompt medical attention to prevent complications.
Rare Diagnoses
- Tuberculosis (TB): Although TB is rare in many parts of the world, it can cause a chronic sore throat among other symptoms. Given the patient's age and the sudden onset of symptoms after a cold, TB would be an unlikely but not impossible diagnosis.
- Malignancy (e.g., Throat Cancer): Throat cancer can present with a persistent sore throat, among other symptoms like difficulty swallowing or a lump in the neck. While rare, any persistent or unexplained sore throat, especially in an older adult, warrants further investigation to rule out malignancy.