A 5-year-old boy is brought to the physician during his summer vacation with 2 days of sore throat, fatigue, and mild headache. He complains of pain with swallowing and has not eaten much in the past day but is drinking small amounts of fluids. He has no underlying health problems and has no other complaints. He takes no medications and has no allergies. His temperature is 38 C (100.4 F). Examination shows pharyngeal erythema with vesicles on the posterior soft palate and no cervical lymphadenopathy. The cardiovascular, respiratory, and abdominal examinations are within normal limits. What is the most likely diagnosis in this patient?

Question

A 5-year-old boy is brought to the physician during his summer vacation with 2 days of sore throat, fatigue, and mild headache.  He complains of pain with swallowing and has not eaten much in the past day but is drinking small amounts of fluids.  He has no underlying health problems and has no other complaints.  He takes no medications and has no allergies.  His temperature is 38 C (100.4 F).  Examination shows pharyngeal erythema with vesicles on the posterior soft palate and no cervical lymphadenopathy.  The cardiovascular, respiratory, and abdominal examinations are within normal limits.  What is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c176_5194_8f63_233c4560c017_MD0005_00 Herpangina is an oropharyngeal infection caused primarily by Coxsackie group A virus. It is usually seen during the summer in children age 3-10, who present with fever, drooling, sore throat, decreased appetite, headache, and painful posterior pharyngeal vesicles. The lesions can evolve rapidly from erythematous macules to vesicles on the soft palate and tonsillar pillars, creating a painful pharyngitis. Herpangina Diagnosis is based clinically on the enanthem. Therapy is directed at symptomatic relief with saline gargles, analgesics, and antipyretics. Cold, non-acidic fluids or popsicles can be soothing and provide hydration. Antiviral therapy is not indicated in this self-limited illness, which typically resolves within a week. Hand-washing by children and their close contacts can prevent spread during outbreaks. (Choice A) Lesions of aphthous stomatitis are often larger and located on the anterior oral mucosa. There are no fevers or systemic symptoms with aphthous ulcers. aphthous stomatitis (Choice B) The absence of anterior cervical lymphadenopathy and tonsillar exudates makes group A streptococcal pharyngitis unlikely in this patient. (Choice D) Primary herpes simplex virus type-1 infection causes gingivostomatitis in children. These patients tend to be febrile and ill-appearing with vesicles on the anterior oral mucosa, gingivae, and perioral skin. perioral skin (Choice E) Infectious mononucleosis usually occurs in adolescence and presents as the classic triad of fever, diffuse bilateral cervical lymphadenopathy, and exudative pharyngitis. The spleen is sometimes enlarged. This patient's young age, absence of cervical lymphadenopathy, and normal abdominal examination make mononucleosis less likely. Educational objective: Herpangina is usually caused by Coxsackie group A virus and characterized by vesicles on the posterior oropharynx. Symptoms resolve within a week. Treatment is supportive with hydration and analgesics. References: Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. (http://www.ncbi.nlm.nih.gov/pubmed/21422083) Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005. (http://www.ncbi.nlm.nih.gov/pubmed/17671037)

A 5-Year-Old Boy Is Brought to the Physician During His