The family physician (FP) suspected strep pharyngitis, but decided to order a rapid strep test to confirm this impression. The test was positive.
The FP explained that the dark area on the tonsil was secondary to infection and would resolve over time. He also told the patient that the cobblestone pattern on the posterior pharynx may have been secondary to a history of allergic rhinitis or could have been newly acquired as part of the strep pharyngitis.
Posterior lymphoid hyperplasia is not a specific finding, even though it is commonly seen in allergic rhinitis and viral pharyngitis. Note, too, that patients may have strep pharyngitis even without tonsillar exudate.
In this case, the patient was given a course of penicillin VK for 10 days. The physician recommended oral analgesics/antipyretics as needed, plenty of fluids, and rest.
Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Williams, B, Usatine R, Smith M. Pharyngitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:213-219.
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