Snapshot A 12-year-old girl presents to her pediatrician for a sore throat. Her symptoms began approximately 1 week ago after she attended a sleepover. Since then she experienced a sore throat and noted a temperature of 101°F (38.3°C). She denies a cough but has noticed increasing fatigue and difficulty swallowing due to pain. On physical exam, she has anterior cervical lymphadenopathy and patchy tonsillar exudates and swelling. A rapid antigen detection test is positive for group A streptococcus infection, which prompted treatment with penicillin V. Introduction Definition inflammation of the pharynx also known as having a "sore throat" Etiology infectious causes bacterial group A streptococcus Corynebacterium diphtheriae viral adenovirus rhinovirus influenza Ebstein-Barr virus coxsackievirus noninfectious causes gastroesophageal reflux disease Differential Pharyngitis Etiology Presentation Workup Treatment Comments Group A streptococcus Symptoms a sore throat fever Physical exam fever patchy tonsillar exudates anterior cervical lymphadenopathy palatal petechiae scarlatiniform rash strawberry tongue Rapid antigen detection test (RADT) Throat score obtained if RADT is negative Penicillin V Benzathine penicillin In patients with a penicillin allergy cephalosporins clindamycin The most common bacterial cause of acute pharyngitis If untreated can result in rheumatic heart disease Corynebacterium diphtheriae Symptoms sore throat cervical lymphadenopathy Physical exam low-grade fever gray membranes bleeds when dislodged This is a clinical diagnosis Confirmed with throat culture Antitoxin Erythromycin Toxoid vaccine prevents diphtheria Ebstein-Barr virus Symptoms fatigue tender symmetric posterior cervical lymphadenopathy Physical exam fever patchy pharyngeal exudates palatal petechiae splenomegaly atypical lymphocytosis Heterophile antibody testing Supportive care such as acetaminophen NSAIDs fluids - Adenovirus Symptoms sore throat laryngotracheitis bronchitis malaise headache myalgia Physical exam conjunctivitis fever This is a clinical diagnosis Supportive care such as acetaminophen NSAIDs fluids - References