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Pharyngitis and Tonsillar Exudates in an 18-Year-Old Woman

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

An 18-year-old woman with no significant medical history and no history of sexual intercourse presented for evaluation of pharyngitis and tonsillar exudates of 1 week duration. She reported neck swelling and an occasional dry cough but no fevers, chills, trismus, headache, dyspnea, chest pain, abdominal pain, fatigue, or rash. One week prior to presentation, she visited an urgent care clinic for evaluation of pharyngitis and white exudates on her tonsils. Results of a rapid strep test and heterophile antibody test (monospot) were negative. A throat culture was obtained and she was prescribed amoxicillin (500 mg twice daily for 10 days) for possible group A streptococcal infection. Despite taking antibiotics for 7 days, she had no improvement in her symptoms. One day prior to presentation, the urgent care clinic notified the patient that her throat culture results were negative.

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An 18-year-old woman with no significant medical history and no history of sexual intercourse presented for evaluation of pharyngitis and tonsillar exudates of 1 week duration. She reported neck swelling and an occasional dry cough but no fevers, chills, trismus, headache, dyspnea, chest pain, abdominal pain, fatigue, or rash. One week prior to presentation, she visited an urgent care clinic for evaluation of pharyngitis and white exudates on her tonsils. Results of a rapid strep test and heterophile antibody test (monospot) were negative. A throat culture was obtained and she was prescribed amoxicillin (500 mg twice daily for 10 days) for possible group A streptococcal infection. Despite taking antibiotics for 7 days, she had no improvement in her symptoms. One day prior to presentation, the urgent care clinic notified the patient that her throat culture results were negative.

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Article Information

Corresponding Author: Kristin Walter, MD, MS, 2800 N Sheridan Rd, Ste 301, Chicago, IL 60657 (Kristin.Walter@amitahealth.org).

Published Online: November 15, 2021. doi:10.1001/jama.2021.19023

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for providing permission to share her information.

References
1.
Centor  RM , Witherspoon  JM , Dalton  HP , Brody  CE , Link  K .  The diagnosis of strep throat in adults in the emergency room.   Med Decis Making. 1981;1(3):239-246. doi:10.1177/0272989X8100100304PubMedGoogle ScholarCrossref
2.
Ebell  MH , Call  M , Shinholser  J , Gardner  J .  Does this patient have infectious mononucleosis? The Rational Clinical Examination systematic review.   JAMA. 2016;315(14):1502-1509. doi:10.1001/jama.2016.2111PubMedGoogle ScholarCrossref
3.
Auwaerter  PG .  Infectious mononucleosis in middle age.   JAMA. 1999;281(5):454-459. doi:10.1001/jama.281.5.454PubMedGoogle ScholarCrossref
4.
Naughton  P , Healy  M , Enright  F , Lucey  B .  Infectious mononucleosis: diagnosis and clinical interpretation.   Br J Biomed Sci. 2021;78(3):107-116. doi:10.1080/09674845.2021.1903683PubMedGoogle ScholarCrossref
5.
Dunmire  SK , Hogquist  KA , Balfour  HH .  Infectious mononucleosis.   Curr Top Microbiol Immunol. 2015;390(pt 1):211-240. doi:10.1007/978-3-319-22822-8 9PubMedGoogle Scholar
6.
Luzuriaga  K , Sullivan  JL .  Infectious mononucleosis.   N Engl J Med. 2010;362(21):1993-2000. doi:10.1056/NEJMcp1001116PubMedGoogle ScholarCrossref
7.
Elgh  F , Linderholm  M .  Evaluation of six commercially available kits using purified heterophile antigen for the rapid diagnosis of infectious mononucleosis compared with Epstein-Barr virus–specific serology.   Clin Diagn Virol. 1996;7(1):17-21. doi:10.1016/S0928-0197(96)00245-0PubMedGoogle ScholarCrossref
8.
Lennon  P , Crotty  M , Fenton  JE .  Infectious mononucleosis.   BMJ. 2015;350:h1825. doi:10.1136/bmj.h1825PubMedGoogle ScholarCrossref
9.
Macsween  KF , Higgins  CD , McAulay  KA ,  et al.  Infectious mononucleosis in university students in the United Kingdom: evaluation of the clinical features and consequences of the disease.   Clin Infect Dis. 2010;50(5):699-706. doi:10.1086/650456PubMedGoogle ScholarCrossref
10.
Bartlett  A , Williams  R , Hilton  M .  Splenic rupture in infectious mononucleosis: a systematic review of published case reports.   Injury. 2016;47(3):531-538. doi:10.1016/j.injury.2015.10.071PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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