October Week 2: Pharyngeal Abscess vs. Tonsillitis


  1. Alcaide M, et al. Pharyngitis and Epiglottitis. Infectious Disease Clinics of North America. Vol 21, Issue 2, June 2007
  2. Gigante, J. Tonsillectomy and Adenoidectomy. Peds in Review. 2005;26:199-203

Case 1
A 17 year-old male presents to your office with complaints of a sore throat and fevers for about 2 days. He says his brothers have been sick with a sore throat and were recently given antibiotics, and he would like some as well. He does not know if his brothers were actually tested for strep throat. On exam, the posterior pharynx is erythematous and his anterior cervical lymph nodes are slightly enlarged and tender.

  • What is your differential diagnosis? What are the most common causes of pharyngitis? 
  • What would your differential diagnosis include if this were a homosexual male with a new sexual partner? 
  • Is a test for strep pharyngitis indicated in this patient? If you decide to test for strep, would you send a rapid strep test or a culture? What would you do if the rapid strep test was negative? 
  • Explain the treatment of strep pharyngitis, the complications of untreated GAS pharyngeal infections, and how to prevent sequelae.

His rapid strep is negative, but you are persuaded by the patient to treat him for strep throat with 10 days of amoxicillin. The patient returns to your office two days later with diffuse maculopapular rash.

  • What is your diagnosis now? What diagnostic tests would you do? What is your treatment?

Case 2
A 5 year-old presented 2 weeks ago with vomiting and fever. A rapid strep at that time was negative, but 2 days later the culture was positive, and he was treated with ten days of PCN.

  • What is the sensitivity and specificity of the rapid strep testing?
  • What is the appropriate antibiotic if the patient is PCN allergic?
  • What percent of exudative pharyngitis in adults and children are due to strep? What are some features of the disease that make it more or less likely to be strep?
  • What is the risk a sibling or schoolmate will get streptococcal pharyngitis?

It turns out that this third episode of tonsillitis in the last year. His mother is tired of bringing him to the doctor and asks you if he can get a tonsillectomy.

  • What are the indications for tonsillectomy in children?