Persistent Throat Pain with White Tonsillar Exudate in Young Adult

Case at a Glance

A 24-year-old female presented with a 3-week history of progressively worsening sore throat, white spots on tonsils, and associated symptoms including ear pain and neck discomfort.

Patient's Story

The patient reported experiencing sore throat symptoms for approximately three weeks with progressive worsening. She described sharp pain during swallowing, generalized throat swelling, and associated ear symptoms including sensation of fullness and itching. The pain extended down to her neck region. She had a significant smoking history (both tobacco and cannabis) over the past two years but had ceased both substances in recent days without symptom improvement. The patient expressed significant anxiety about her condition and was planning to seek urgent medical care.

Initial Assessment

Physical examination revealed white exudative lesions on the tonsillar surfaces with apparent tonsillar enlargement. The patient demonstrated signs of pharyngeal inflammation with associated cervical discomfort. Otalgia was present bilaterally with reported sensation of ear fullness.

The Diagnostic Journey

Given the 3-week duration and white tonsillar exudate, differential diagnosis included bacterial pharyngitis (particularly Group A Streptococcus), viral pharyngitis, infectious mononucleosis, or candidal infection. The patient's recent smoking cessation and previous endoscopic examination (6 weeks prior showing normal findings) were noted. Laboratory workup and throat culture were indicated to determine the infectious etiology.

Final Diagnosis

Pending laboratory confirmation - likely bacterial pharyngitis with tonsillar exudate, possibly streptococcal pharyngitis given the clinical presentation and duration.

Treatment Plan

Immediate evaluation in urgent care setting for throat culture and rapid strep testing. Empirical antibiotic therapy consideration pending culture results. Symptomatic management with analgesics and throat lozenges. Patient counseling on smoking cessation benefits and follow-up instructions for worsening symptoms.

Outcome and Follow-up

Patient advised to seek immediate medical attention as planned. Follow-up arranged based on culture results and clinical response to treatment. Monitoring for potential complications given the prolonged course and severity of symptoms.