Severe Unilateral Pharyngitis with Dysphagia in Young Adult

Case at a Glance

A 21-year-old female presented with severe right-sided throat pain progressing to complete dysphagia over 24 hours, requiring urgent care intervention for symptom management.

Patient's Story

The patient initially noticed mild right-sided throat discomfort during her work shift on Thursday evening. The pain progressively worsened throughout her shift, making swallowing increasingly difficult. By Friday morning, she was unable to swallow saliva and experienced severe pain. The condition deteriorated further, preventing sleep due to choking on secretions when lying supine. She was forced to sleep on her side to allow saliva drainage.

Initial Assessment

Upon emergency department evaluation, the patient appeared distressed with visible right tonsillar erythema and swelling. Associated symptoms included right-sided facial, jaw, and head pain. She demonstrated significant dysphagia with inability to manage oral secretions. Vital signs were stable. Physical examination revealed unilateral tonsillar inflammation without obvious abscess formation.

The Diagnostic Journey

Initial diagnostic workup included rapid strep test, COVID-19 PCR, influenza testing, and monospot test - all returned negative results. The patient was discharged from the emergency department with a viral pharyngitis diagnosis. Due to persistent and worsening symptoms, she sought care at urgent care the following day where clinical assessment suggested possible peritonsillar involvement requiring aggressive symptomatic treatment.

Final Diagnosis

Severe viral pharyngitis with unilateral tonsillar inflammation, likely secondary to current circulating viral strain causing characteristic 'razor blade throat' symptomatology. Rule out peritonsillar abscess given asymmetric presentation.

Treatment Plan

Multimodal approach including intramuscular dexamethasone injection for anti-inflammatory effect, oral corticosteroids for continued inflammation control, empirical antibiotic coverage given asymmetric presentation, and viscous lidocaine for topical anesthesia. Supportive care with liquid analgesics and aggressive hydration. Patient advised to return if symptoms worsen or voice changes develop.

Outcome and Follow-up

Patient experienced significant symptom improvement within hours of steroid administration. Pain decreased substantially, allowing for fluid intake and nutrition. Continued symptomatic management with liquid pain medications proved effective. Patient advised to monitor for complications and return for reassessment if unable to maintain adequate oral intake or if symptoms progress.