22 y/o F patient returned to clinic. 7 days into 10 day course of amoxicillin. reports worsened symptoms including great difficulty swallowing, intermittent sweating episodes, extreme fatigue, and new onset upper airway swelling that causes difficulty speaking. Of note during visit, the PT held nose in "sniffing" position for ease of breathing. Pt reported new onset rash (3rd photo) spreading from trunk to limbs and neck. significant jugular swelling noted (4th photo) along with inflamed posterior and anterior lymph chains. Suggestions please

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Yes diphtheria should be r/o Pt has viral xenthma Acute fulminating tonsilitis Hospitalise treat with broadspectrum iv antibiotics and antiinflamatory Swab for c&s beside routine investigations

Thanx dr Pushkar Bhomia
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Acute exacebation of chronic tonsilitis. Grade 4 tonsillar hypertropy present. Sir, is jugular swelling due to JD Lymph nodes, or thrombosed Jugular vein or something else. Beter to admit patient and start with strong IV antibiotics( inj ceftriaxone can be considered). NSIDS, Steroids can be used like Deflazacort, PPI and suppotive sreatment. Nebulization and supportive treatment.Examine the larynx aswell for inflamation or any membrane. Sent for a throat culture and sensitivity. Once infection is cotrolled give the patient an option yo undergo tonsillectomy after 6 months. Also rule out Diptheria.

Severe follicular tosillitis with erythema marginatum Scarlet fever in diptheria membrane is formed in this no membrane

Thanx Dr Shivraj sir
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Acute tonsillitis with drug rash change to azithro 500 hs levofloxacillin 500 od metrogyl 400 mg tds chymoral forte tds atarax bd levocet bd

Oropharyngeal candidiasis Do rule out immunocompromised state

Diphtheria should be considered . Throat swab should be checked , DD Infectios mononucleosis, the rash being due to Amoxycillin

Follicular tonsillitis with erythema marginatum

Thanks Dr Dinesh Gupta
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SUGGESTIVE. OF.. INFECTITIOUS MONONUCLEOSIS...

Follicular tonsillitis

Fulminating tonsillitis throat swab culture &treat with appropriate antibiotic, together with anteinflamatory, betadine gargle with lukewarm water .

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