A Case of Sore Throat and Fever

A previously healthy 41-year-old man presented to his primary care physician because of sore throat. He noticed the symptom two days ago, that was sixteen days before his admission. He had not had rhinorrhea or a cough, and his temperature was normal. He had mild erythema on his pharynges, and mild tenderness of the anterior neck. His primary care doctor performed laryngoscopy, which denied the swelling of his epiglottis. He was diagnosed as pharyngitis, and an antibiotic and an anodyne were prescribed. His symptoms subsided after four days, but mild soreness of his throat persisted. Seven days before his admission, he developed headache and high grade fever (39°C). Two days before his admission, he visited another primary care doctor. Cefcapene pivoxil hydrochloride was prescribed but it didn’t help him. The day before his admission, the antibiotic was changed to amoxicillin/clavulanate potassium. However, his sore throat, headache, fever, fatigue got worsen, so he decided to consult our hospital. At first, he visited to the Department of Neurology, in afraid of meningitis. Lumbar puncture was performed, and meningitis was denied. Focus of fever was unknown at this time, so he was admitted and consulted to the internal medicine team. He was married and worked as system engineer. He denied any use of alcohol, cigarettes, or illicit drugs. He had no remarkable past medical history, and took no medications. He had not recently traveled outside Japan, and had not had any recent contact with sick persons or animals.