Post-Streptococcal Persistent Throat and Tongue Pain with Secondary Thrush

Case at a Glance

A 45-year-old active female presents with persistent throat and tongue pain following treated streptococcal pharyngitis, subsequently developing oral thrush with ongoing unilateral symptoms despite antifungal treatment.

Patient's Story

The patient is a 45-year-old female, 5'4" and 150 pounds, who maintains an active lifestyle including marathon running and hiking. Her medical history is significant for lifelong geographic tongue and a previous smoking history (half pack daily from ages 18-28). She takes only vitamin D supplementation and occasionally uses cannabis edibles. On June 16th, she developed acute illness with fever (100.5-101.5°F), sore throat, and fatigue. Three days later, she sought medical attention and tested positive for streptococcal infection.

Initial Assessment

Initial presentation included classic streptococcal pharyngitis symptoms with positive rapid strep test. Patient was prescribed amoxicillin 500mg twice daily for 10 days. While fever and fatigue resolved during antibiotic treatment, throat discomfort persisted along with the development of severe tongue pain and dry cough with occasional morning purulent sputum.

The Diagnostic Journey

Following completion of antibiotic therapy, the patient continued experiencing throat and tongue pain with persistent dry cough. Despite maintaining normal vital signs and energy levels sufficient for strenuous hiking activities, symptoms persisted for several weeks. A follow-up visit on July 9th revealed negative strep testing, and clinical examination suggested oral thrush, leading to nystatin therapy initiation.

Final Diagnosis

Post-streptococcal persistent pharyngitis complicated by secondary oral candidiasis (thrush), likely related to antibiotic use disrupting normal oral flora.

Treatment Plan

Initial treatment with amoxicillin 500mg twice daily for streptococcal infection, followed by nystatin oral suspension four times daily for oral thrush. Symptomatic management with acetaminophen and ibuprofen as needed for pain control.

Outcome and Follow-up

Patient reports partial improvement with antifungal therapy but continues to experience unilateral left-sided throat and tongue pain with associated ear discomfort after nearly one month of symptoms. The persistence of unilateral symptoms raises consideration for further evaluation to rule out other underlying conditions, particularly given the extended symptom duration and incomplete response to current therapy.