100 Cases in Clinical Medicine

CASE 65: SORE THROAT

History

A normally healthy man aged 28 years developed an acute sore throat for which he con-
sulted his general practitioner (GP). A diagnosis of acute pharyngitis was made, presumed
streptococcal, and oral penicillin was prescribed. The sore throat gradually improved, but
5 days later the patient noted a rash on his arms, legs and face, and painful ulceration of
his lips and mouth. These symptoms rapidly worsened, he felt very unwell and presented
to the emergency department. There was no relevant previous medical history or family
history. He has had sore throats occasionally in the past but they have settled with throat
sweets from the chemist.

Examination

He looked ill and had a temperature of 39.2°C. There were erythematous tender nodules
on his arms, legs and face, and ulcers with some necrosis of the lips and buccal and pha-
ryngeal mucosae. The rest of the examination was normal.

Normal

Haemoglobin 13.8 g/dL 13.3–17.7 g/dL

White cell count 14.8% 109 /L 3.9–10.6% 109 /L

Platelets 334 % 109 /L 150–440% 109 /L

Blood film: neutrophil leucocytosis

His chest X-ray is shown in Fig. 65.1.

INVESTIGATIONS

Figure 65.1Chest X-ray.

Questions

• What is the diagnosis?


• What is the management?