Prolonged Group A Streptococcal Pharyngitis Despite Antibiotic Treatment

Case at a Glance

A 24-year-old male presents with persistent throat pain and unilateral lymphadenopathy on day 8 of antibiotic treatment for confirmed Group A Streptococcal pharyngitis, despite resolution of systemic symptoms.

Patient's Story

The patient developed acute pharyngitis with high fever, severe headaches, significant throat swelling, and characteristic white exudates on the tonsils. Laboratory confirmation revealed Group A Streptococcus. He was prescribed a 10-day course of oral antibiotics. While his fever, headaches, and throat swelling have completely resolved along with the white patches, he continues to experience pain with swallowing and mild chin discomfort. He also notes persistent unilateral lymph node swelling on the affected side. The patient recalls that previous episodes of strep throat resolved more quickly and is concerned about the prolonged recovery time. He has an upcoming trip planned and is seeking reassurance about travel safety.

Initial Assessment

Physical examination revealed resolved systemic signs of infection with persistent localized symptoms including odynophagia and unilateral cervical lymphadenopathy. The patient appeared otherwise well with vital signs within normal limits.

The Diagnostic Journey

Initial diagnosis was confirmed through appropriate laboratory testing showing Group A Streptococcus. The patient responded well to antibiotic therapy for systemic symptoms but showed incomplete resolution of local pharyngeal symptoms despite 8 days of treatment.

Final Diagnosis

Group A Streptococcal pharyngitis with prolonged local symptoms despite appropriate antibiotic therapy. Differential considerations include incomplete resolution, potential complications such as peritonsillar abscess, or secondary bacterial infection.

Treatment Plan

Continue current 10-day antibiotic course as prescribed. Symptomatic management with analgesics for pain control. Patient education regarding the primary purpose of antibiotic therapy in strep throat being prevention of complications rather than symptom duration reduction.

Outcome and Follow-up

Patient advised to complete full antibiotic course and return for evaluation if symptoms persist beyond treatment completion. Specific monitoring for signs of complications such as peritonsillar abscess recommended. Follow-up appointment scheduled post-antibiotic course if symptoms do not fully resolve.