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Unusually Severe Pharyngitis in a 19-Year-Old Woman

Unusually Severe Pharyngitis in a 19-Year-Old Woman

A previously healthy 19-year-old woman presents with a sore throat that has become progressively more painful over the course of 1 week. She also has left-sided neck swelling, light-headedness, and intermittent headaches. She denies recent sexual activity.

Self-medication with throat lozenges provided no relief. Fever and profuse sweating subsequently developed, and the pain eventually became so severe that she was unable to eat.

PHYSICAL EXAMINATION

The patient is diaphoretic. She has bilateral tonsillar exudate, submental and submandibular lymphadenopathy, decreased active and passive range of motion of the neck with tenderness on the left side, and trismus. Results of cardiac, pulmonary, abdominal, and neurological examinations are unremarkable.

LABORATORY AND IMAGING RESULTS

Laboratory studies reveal leukocytosis (white blood cell count, 21,800/?L) with bandemia (band count, 18%). A mononucleosis spot test yields a negative result. A chest radiograph shows multiple bilateral nodular opacities. A CT scan of the neck reveals left internal jugular thrombosis, palatine tonsillitis, and peritonsillar

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