Case No 2

31-year old man admitted to hospital for two-day rising sore throat, odynophagia, and fever

Medical History

Present Illness: Two-day growing pain in neck, left side, pain restrict to almost no swallowing, chill in the morning, cannot fully open the mouth. Examined at Outpatient ENT Dpt, sent to ID Dpt to treat with parenteral antibiotic.

ROS (Review of Systems): Nothing worth considering except mentioned in past history.

FHx: Insignificant for present illness
EHx: Homosexual contact with stable partner, last was 14 days before, oral, negative HIV test three years ago
WSHx: Office worker, single, living with his partner
PM/SHx: hypothyreosis, surgery: left-sided tonsillectomy for peritonsillar abscess 4 years ago, laparoscopic cholecystectomy 5 years ago
Allergies: none
Medications: Letrox 50 µg tbl 0-0-1 tabl qd po
Abuse: 20 cigarettes daily, not using drugs.

Physical Examination

VS: T 38 °C, HR: 122, RR: 18, BP: 126/94, SpO2: NA.
General: Alert, oriented, eupneic. Freely mobile. Eutrophic appearance.
Skin: Normal color. No rash, lesions, ulcerations, subcutaneous nodules or induration
Eyes: PERRL, EOMI. No scleral icterus.
ENT: Nares without any discharge. Mucous membranes moist. Oropharynx edematous and slightly erythematous. Left tonsil is enlarged, cleft and covered with numerous white coatings (pseudomembranes), protruding to midline. White coated tongue, foetor ex ore (halitosis).
Neck: Jugular vein filling not increased. Neck is supple, no masses, no thyroid enlargement.
Lymph Nodes: Submandibular lymph nodes are not distinctly swollen, on the left side tender and probably fluctuating.
Cardiovascular: Tachycardia. Heart sounds S1 and S2 normal, no m/g/r. Pulses 2+ equal on both sides.
Lungs: Clear to auscultation bilaterally, normal respiratory effort.
Abdomen: Abdomen muscular, small scars of older date, NT, ND. Liver and spleen not palpable. No rebound or guarding. Normal bowel sounds.
Extremeties: No bilateral cyanosis, clubbing or edema.
MSK: Normal alignment, mobility.
Neurological: Cranial nerves II-XII grossly intact, meningeal signs negative, movements and muscle strength of the extremities symmetrical.


Photograph of the oral cavity   Fig. 1 First view into the oral cavity


Photograph of the oral cavity   Fig. 2 Second view into the oral cavity


Pertinent Laboratory Tests

Hematologic exam:

Biochemic exam:

Microbiology laboratory tests:

Imaging and Other Investigations



Neck CT scan   Fig. 3 Neck CT scan


Diagnostic Conclusion


Propose medicamentous treatment



5 Oral cavity infections and upper respiratory tract infections
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