Level 2: Fatigue – Contrasting Case #3: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a pleasant 16 year old girl who presents to her primary care physician accompanied by her mother. She is of normal body habitus and is in no acute distress. Patient reports about three weeks ago she started feeling tired all the time. At that time she also started having a daily fever of 102 F. About two weeks ago she reports a sore throat that is still present. One week ago, since the sore throat did not resolve, she went to a Prompt Care and was treated for strep pharyngitis with amoxicillin. She reports they did not do a throat swab at that time. She is currently on day 7 of 10 of amoxicillin and has not missed a dose. She says her throat does not seem to be getting any better. She does not report a cough, rhinorrhea, conjunctivitis, or dysphagia. She also notes that about 5 days ago she started to get a rash all over her body that lasted a few days before resolving. The rash did not itch. There are no current sick contacts, but her boyfriend had a sore throat about a month ago.

Patient has no known medical conditions. She does not take any medications, vitamins, or supplements.
She is a sophomore in high school where she is on the honor roll and is currently playing varsity basketball.

Vitals: Height 5’6, weight 135 lbs, HR 62, BP 118/62, RR 16, temp 101.4 F
Physical exam is normal except for the following: Bilateral tender posterior cervical lymphadenopathy, pharyngeal inflammation/erythema, tonsillar exudate, and splenomegaly

Labs: +heterophile antibody, lymphocytosis and increased circulating atypical lymphoctyes