What's The Take Home?

A 20-Year-Old Man With A Severe Sore Throat And Fatigue

Ronald N. Rubin, MD1,2 Series Editor

  • Introduction. A 20-year-old college student was admitted for care following a visit to student health at his university.

    Patient history. During the previous week, he developed a sore throat that progressively worsened, and he felt fatigued. Although he initially attributed his sore throat to intense studying for finals and his fatigue to sleep loss, after completing his exams, he still felt so badly that he felt it was necessary to get evaluated at student health. The student has no major medical or surgical diagnoses or issues and is fully compliant and current with all vaccinations. He does not take any medicines on a regular basis, only acetaminophen in the last week. He does not use drugs but does drink alcohol in weekend party settings routinely during the school year. He is heterosexually active and uses condoms.

    Physical examination. His physical exam revealed a temperature of 38.6 C and pulse of 104; BP 110/70 and respirations of 14/min. Head, eyes, ears, nose, and throat exam is positive for an injected throat with a gray membrane on the left tonsil. Chest and heart are unremarkable as is the abdomen, specifically with no enlargement of the liver or spleen. There are no enlarged lymph nodes. His skin shows petechiae on the ankles. Basic and comprehensive chemistry panels including bilirubin were normal.

    Diagnostic testing. His complete blood count was abnormal, which resulted in his referral to the hospital. His hemoglobin was 8.8 gms/DL. His white blood cell (WBC) count was 700/DL with 20% polymorphonuclear neutrophils forms and 70% lymphocytes and his platelets were 11,000/DL. The WBC differential and smear did not show any abnormal forms.

    (Answer and discussion on the next page)