A 5-year-old boy presents to the emergency department with a two-day history of fever, sore throat, and difficulty swallowing. On examination, he has multiple small, grayish-white papulovesicular lesions on the soft palate, uvula, and tonsillar pillars. He is otherwise alert and well-hydrated with stable vital signs. Which of the following is the most likely diagnosis?
A) Peritonsillar abscess
B) Herpangina
C) Hand-foot-and-mouth disease
D) Infectious mononucleosis
E) Scarlet fever
Explanation:
Herpangina is characterized by the sudden onset of fever, sore throat, and dysphagia, accompanied by small, vesicular lesions on the posterior oropharynx, typically involving the soft palate, uvula, and tonsillar pillars. The lesions are grayish-white and may be surrounded by erythema. It is caused by Coxsackievirus group A, primarily affecting young children. Treatment is supportive, focusing on pain management and hydration. Peritonsillar abscess (choice A) presents with severe throat pain, trismus, and unilateral tonsillar swelling. Hand-foot-and-mouth disease (choice C) manifests with oral ulcers and vesicles on the hands and feet. Infectious mononucleosis (choice D) presents with fever, sore throat, lymphadenopathy, and atypical lymphocytosis. Scarlet fever (choice E) presents with a sandpaper-like rash and strawberry tongue, secondary to group A Streptococcus infection.
Therefore, the correct answer is B) Herpangina
References: Tintinalli’s Emergency Medicine Manual, 9th Edition
