An Unusual Sore Throat

Abstract

<P>A previously healthy 15-year-old Hispanic boy presented to the emergency room with a history of fever and sore throat. Both symptoms began 4 days prior and progressed to include vomiting, difficulty swallowing, diarrhea, back pain, and generalized malaise. Initial vitals were temperature 100.2, heart rate 100/min, respiratory rate 20/min, blood pressure 90/73, and capillary refill time more than 2 sec. He appeared ill and dehydrated but oriented to time, place, and person. His physical exam was notable for erythema and prominence of left anterior tonsillar pillar with deviation of uvula to right side, positive trismus, and mild swelling and tenderness of the left lateral neck. Other systemic examination including respiratory, cardiovascular, abdominal, and neurological were unremarkable. Lab evaluation demonstrated WBC 23.8 with neutrophils of 95%, platelets 100, BUN 128, creatinine 2, CRP 36.33, and Ca 7.8. Urine analysis showed proteinuria and hematuria. Throat swab, blood, and urine were sent for culture. Rapid monospot test was negative. He received two IV fluid boluses. Clindamycin was started, and he was admitted to the PICU for further management.</P><H4>ABOUT THE AUTHORS</H4><P>Rajesh Dudani, MBBS, is Pediatrics Resident; and Norman Jacobs, MD, is Attending Physician, Pediatric Infectious Disease, John H. Stroger Hospital of Cook County, Chicago.</P><P>Address correspondence to: Rajesh Dudani, MBBS, 1926 W Harrison St, #1801, Chicago IL, 60612; fax 312- 864-9717; or e-mail <a href="mailto:dudanirajesh@gmail.com">dudanirajesh@gmail.com</a>.</P>