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Clinical Challenge
May 2, 2019

An Unusual Sore Throat

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University (OHSU), Portland, Oregon
JAMA Otolaryngol Head Neck Surg. 2019;145(7):678-679. doi:10.1001/jamaoto.2019.0612

A 27-year-old man with a history of pharyngeal gonorrhea presented with a 7-day history of severe sore throat and odynophagia, worse when swallowing solids than liquids. Owing to the odynophagia, he had presented to the emergency department for dehydration. At that time, he was febrile to 101°F and denied any dysphonia or dyspnea. The results of a rapid Streptococcus test, recent HIV screen, and a rapid plasma reagin test were all negative. He denied any genital lesions or symptoms at that time. He had been taking prophylactic emtricitabine-tenofovir daily and had received his last diphtheria booster 2 years prior to presentation. Treatment with amoxicillin clavulanate over several days had not prevented a worsening of his symptoms. On physical examination, there was no cervical lymphadenopathy, and there were no genital lesions. Flexible fiber-optic nasopharyngoscopy showed ulcerative lesions with exudate and erythema extending diffusely along the base of tongue, oropharynx, nasopharynx, hypopharynx, and epiglottis (Figure 1).

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