The Case Files: Patient with Sore Throat, Difficulty Swallowing, and Fever

By Joseph Hourizadeh, DO; Richard D. Susi, MD; Joseph Kelly, MD; & Afaq Sharieff, MD A 56-year-old man arrived by car to the emergency department complaining of sore throat, difficulty swallowing, and fever. The patient was previously healthy and up to date with his immunizations. He reported that the pain had started roughly 14 hours earlier and had intensified. He had taken ibuprofen and acetaminophen with no relief. He mentioned that he had pain in his throat, increasing dysphagia, and increasingly difficulty swallowing. He did not complain of any shortness of breath or difficulty breathing. Oral temperature taken at home was 100.4°F. Vital signs were normal with the exception of tympanic temperature measuring 101.6°F. The patient was alert and oriented, in pain, and leaning forward with his neck extended. The anterior cervical lymph nodes were enlarged and tender bilaterally. Physical examination was normal with the oropharynx showing no tonsillar enlargement, exudate, or erythema. Two blood cultures taken on the day of admission grew Haemophilus influenzae Type b (Hib). The patient was admitted to the intensive care unit for observation, and otolaryngology was consulted. His condition improved with intravenous hydration, antibiotics, steroids, and nebulizer treatments. H. influenzae is serologically differentiated into six unique strains (a-f) based on structural differences in the polysaccharide envelope. (J Infect Dis 2003;187[1]:109.) Those strains witho...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research