Pharyngitis — Differential Diagnosis — Clinical Pathway: Emergency Department and Inpatient

Suspected Pharyngitis or Peritonsillar Abscess (PTA) Clinical Pathway — Emergency Department and Inpatient

Differential Diagnosis

  • Infectious pharyngitis
    • Bacterial pharyngitis: most commonly group A Streptococcus
      • Potentially sexually active: consider N. gonorrhoeae, chlamydia pneumonia
      • Atypical: mycoplasma pneumonia, diphtheria
    • Viral pharyngitis: adenovirus, Coxsackie virus, coronaviruses (COVID-19), infectious mononucleosis (EBV, CMV), HSV, HIV
      • Consider infectious mononucleosis when atypically prolonged timeline +/- tender LAD
    • Rare: candidal pharyngitis, Lemierre syndrome (Fusobacterium necrophorum)
  • Irritant pharyngitis: temperature, allergic
  • Trauma: penetrating, abrasion, thermal, chemical/ingestion, foreign body
  • Deep Space Neck Infections: retropharyngeal abscess, peritonsillar abscess
  • Croup (viral laryngotracheitis)
  • Uvulitis
  • Epiglottitis
  • Bacterial tracheitis
  • Systemic inflammatory conditions: Kawasaki Disease, Stevens-Johnson syndrome, Behçet's syndrome, periodic fever with aphthous stomatitis, pharyngitis and adenitis (PFAPA syndrome)
  • Oncologic or other tumors
  • Psychogenic, globus sensation

Complications of PTA

  • Airway obstruction
  • Sepsis
  • Aspiration pneumonia
  • Internal jugular vein thrombosis
  • Jugular vein suppurative thrombophlebitis (Lemierre syndrome)
  • Carotid artery rupture
  • Mediastinitis (suggested by widening of the mediastinum on chest radiograph)
  • Atlantoaxial dislocation