Persistent Throat Irritation Following Streptococcal Pharyngitis with Uvular Swelling

Case at a Glance

A 31-year-old male presents with persistent throat irritation and discomfort lasting two months following successfully treated streptococcal pharyngitis that initially presented with uvular swelling.

Patient's Story

The patient initially presented on May 6th with acute onset of uvular swelling without associated pain. He was diagnosed with streptococcal pharyngitis and prescribed antibiotic therapy. Despite completing nearly the full course of antibiotics (missing only 2 pills), he has experienced persistent throat symptoms for two months post-treatment. He describes the sensation as feeling like 'someone is rubbing my throat with a feather aggressively' and reports intermittent dry, sandpaper-like texture in his throat. The discomfort is temporarily relieved by eating and drinking but returns immediately after swallowing. Initially bilateral, symptoms have now localized primarily to the left throat near the tonsillar area.

Initial Assessment

Physical examination reveals minimal erythema with otherwise normal-appearing oral cavity and appropriately sized tonsils. Multiple healthcare providers, including emergency department physicians, urgent care providers, primary care physician, and dentist, have found no obvious signs of active infection or structural abnormalities. Strep testing performed on May 16th was negative by both rapid test and culture.

The Diagnostic Journey

The patient has been evaluated by multiple healthcare providers over the past month, including emergency department, urgent care, primary care, and dental professionals. All examinations have been reassuring with no evidence of ongoing infection. The patient notes cyclical 'flare-ups' lasting approximately one week, during which symptoms intensify, followed by periods of milder but persistent discomfort. Currently, he reports posterior pharyngeal involvement with visible bumpy texture and sensation of heat. An ENT consultation has been arranged for further specialized evaluation.

Final Diagnosis

Post-infectious pharyngeal irritation syndrome, likely post-streptococcal inflammatory response with possible component of laryngopharyngeal reflux or chronic pharyngitis. Differential considerations include post-viral syndrome, allergic pharyngitis, or vocal cord irritation.

Treatment Plan

Symptomatic management with throat lozenges, warm salt water gargles, and adequate hydration. Consider trial of proton pump inhibitor therapy for possible reflux component. ENT evaluation for laryngoscopy and further assessment of laryngopharyngeal anatomy. Patient education regarding expected timeline for post-infectious symptoms and reassurance regarding benign nature of findings to date.

Outcome and Follow-up

Patient reports additional symptom of mild pain with yawning or gargling, with first swallow after these activities being particularly uncomfortable. Awaiting ENT consultation for specialized evaluation and potential laryngoscopy. Patient experiencing significant health anxiety related to persistent symptoms and seeking reassurance about timeline for resolution.