A 62-year-old healthy man with no recent travel history or sick contacts presented with 2 weeks of midline sore throat without systemic signs, such as fever, myalgia, or rash. A physical examination, including flexible laryngoscopy, revealed cobbling, adherent, thick yellow mucus and ulceration of the uvula (Figure 1A).
Empirical treatment with augmentin and nystatin oral suspension for possible bacterial or fungal pharyngitis was unsuccessful, with symptoms worsening during the subsequent 2 weeks. Results of laboratory testing for group A Streptococcus, COVID-19, and mononucleosis were negative. A tissue biopsy was performed, and results of pathology revealed epithelial hyperplasia with suppurative granulomatous inflammation without evidence of dysplasia or malignancy. There was no evidence of fungal or acid-fast organisms. Tissue culture revealed only normal respiratory flora. Additional treatment with fluconazole, augmentin, doxycycline, omeprazole, prednisone, and bactrim failed to improve symptoms.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Nsangou Ghogomu, MD, MA, Colorado Permanente Medical Group, 2045 N Franklin St, Denver, CO 80205 (firstname.lastname@example.org).
Published Online: August 17, 2023. doi:10.1001/jamaoto.2023.2223
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information. We also wish to acknowledge the contributions of Marcia Eustaquio, MD (Head & Neck Surgery, Colorado Permanente Medical Group); Daniel Mogyoros, MD (Infectious Diseases, Colorado Permanente Medical Group); Martin Potash, MD (Surgical Pathology, AP/CP Colorado Pathology Consultants); and the University of Washington Medicine Molecular Microbiology Laboratory, Seattle, Washington. These contributors were not compensated beyond their regular salaries.
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:
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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