Case Study – An unusual sore throat

A woman aged 67 years with a history of childhood tonsillectomy presented with complaints of a severe sore throat and pain on swallowing. She had not been not feeling well since the beginning of the week, and by the middle of the week her throat was sore and red. She was initially diagnosed with tonsillitis of post-surgical tonsillar remnants and prescribed cephalexin. Her symptoms had progressively worsened by the end of the week, with pain extending to the left jaw and ear, and with swallowing.

On examination, her body temperature was 37.5°C, pulse was 90 bpm and regular, blood pressure was 122/80 mmHg and oxygen saturation on pulse oximeter was 97% on room air. The airway was clear and she was breathing without difficulty.

Examination of the throat revealed vesicles extending from the left side of the soft palate to the tonsillar pillar and beyond (Figure 1). The uvula was central in position and movements of the soft palate were normal. The affected area of the throat was tender to touch (during swab collection), very sensitive to cold water and had an altered sense of taste to chocolate. The cervical lymph nodes were enlarged on the left side. There was no tragus, mastoid or temporomandibular joint tenderness present. The ear canal and tympanic membrane examination were normal.