Case 2: Sore Throat and Dysphagia in a 6-year-old Boy

Joshua A. Belfer, MD* 1. *Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY A previously healthy, fully vaccinated 6-year-old boy presents to the emergency department with sore throat and difficulty swallowing starting the previous evening. That morning the boy had complained of difficulty swallowing when eating breakfast and was noted to have some drooling. He was given acetaminophen before presenting to the emergency department. The boy has a history of enlarged tonsils, but no other pertinent medical history. At presentation, he is febrile (102.7°F [39.3°C]), with a heart rate of 151 beats/min, respiratory rate of 20 breaths/min, blood pressure of 109/63 mm Hg, and oxygen saturation of 99% on room air. On physical examination the boy is noted to be ill appearing, with enlarged and erythematous tonsils. Neck examination is significant for tenderness on the lateral aspects bilaterally, with lymphadenopathy of ∼2 cm noted on the left and right sides of the neck. There is no stridor or voice change, and the boy has clear breath sounds bilaterally on auscultation. His neck is observed to be supple, with no restriction in range of movement. Laboratory studies reveal a white blood cell count of 34,000/mL, with 94% neutrophils on the differential cell count. A metabolic panel shows a bicarbonate level of 18 mEq/L (18 mmol/L) but is otherwise normal. Uric acid and lactate dehydrogenase levels are normal. Results …