Visual Diagnosis: Sore Throat and Difficulty Swallowing in a 9-year-old Boy

Nirav Shastri; Gretchen Black; Milton A. Fowler

doi:10.1542/pir.32-5-215

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Nirav Shastri, MD, FAAP*
Gretchen Black, DO*
Milton A. Fowler Jr, MD, FACEP^†

^*Assistant Professor of Pediatrics, University of Missouri, Kansas City, MO; Children's Mercy South Urgent Care Center, Overland Park, KS.
^†University of Missouri, Kansas City, MO; Section Chief, Children's Mercy South Urgent Care Center, Overland Park, KS.

Author Disclosure
Drs Shastri, Black, and Fowler have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 9-year-old boy presents with sore throat and difficulty swallowing of 3 days' duration. He was seen at a clinic on the first day of his illness, where the result of a rapid streptococcal antigen test was negative. He was discharged with a diagnosis of sore throat with cough and prescribed a 5-day course of azithromycin and a 3-day course of prednisolone suspension. However, his sore throat has persisted and his dysphagia has worsened. His mother is seeking further medical attention because she has noted the roof of his mouth to be red and swollen posteriorly. The boy describes a feeling that “something is stuck in my throat” but still can swallow. Dysphagia occurs with both solids and liquid foods.

On physical examination, his vital signs are within normal limits; there is no fever or respiratory distress. Examination of the pharynx reveals an erythematous, swollen uvula (Fig. 1). He has no drooling, cervical lymphadenopathy, or erythema or exudate on his pharyngeal wall. No …