Severe Throat Pain and Dysphagia in 32-Year-Old Female with History of GERD

Case at a Glance

A 32-year-old female presented with severe throat pain and difficulty swallowing, progressing over 4-5 days without systemic symptoms, following consumption of spicy food.

Patient's Story

The patient reported excruciating throat pain that began mildly 4-5 days prior and progressively worsened to an unbearable level. She described a constant burning sensation localized behind the uvula rather than in the tonsils, accompanied by difficulty swallowing saliva and a sensation of incomplete swallowing. The pain was refractory to multiple analgesics including acetaminophen, ibuprofen, topical anesthetics, and salt water gargles. The patient noted consuming spicy pho at 9 PM followed by immediate bedtime, after which symptoms significantly worsened. She denied fever, congestion, cough, rhinorrhea, headache, or constitutional symptoms.

Initial Assessment

Physical examination revealed erythematous throat with cobblestone appearance of posterior pharynx and significant inflammation without tonsillar enlargement. Vital signs were stable with no fever. The patient appeared uncomfortable but alert and oriented.

The Diagnostic Journey

Rapid strep test and COVID-19 test were both negative. Given the patient's history of gastritis, gluten sensitivity, and recent consumption of spicy food followed by recumbency, gastroesophageal reflux disease (GERD) with laryngopharyngeal reflux was considered as the primary differential diagnosis. The temporal relationship between spicy food consumption and symptom exacerbation supported this hypothesis.

Final Diagnosis

Laryngopharyngeal reflux (LPR) secondary to gastroesophageal reflux disease, likely precipitated by spicy food consumption and immediate recumbency.

Treatment Plan

Proton pump inhibitor therapy, dietary modifications including avoidance of spicy foods, elevation of head of bed, avoidance of eating within 3 hours of bedtime, and symptomatic management with throat lozenges and adequate hydration.

Outcome and Follow-up

Patient was advised to follow up in 48-72 hours if symptoms did not improve or worsened, with consideration for laryngoscopy if symptoms persisted beyond one week of treatment.