WHAT’S CAUSING THIS MAN'S CHRONIC SORE THROAT?
A 46-year-old man has had a chronic sore throat for eight years. He travels frequently, particularly to India, where he spends his time in a large city not endemic for any specific diseases. In January 2001, a throat culture was positive for Hemophilus influenzae. The ear, nose, and throat specialist who saw him at that time recommended medical treatment. No vocal-cord or pharyngeal masses were found. All other cultures have been negative. Nasal steroids and antihistamines prescribed for postnasal drip have provided some relief. A complete metabolic profile, complete blood count, thyroid-stimulating hormone, as well as testing for HIV, hepatitis B, Epstein-Barr virus, cytomegalovirus, Lyme disease, rheumatoid factor, and antinuclear antibodies were negative. An erythrocyte sedimentation rate was 60 mm/hr. Is my patient’s sore throat secondary to allergic rhinitis? Or am I missing something?
—Leonard D. Genovese, DO, Brooklyn, N.Y.
Judging from the patient’s response to treatment for allergic rhinitis, it certainly sounds like this diagnosis may account, at least in part, for his sore throat. Still, sore throat from postnasal drip is typically intermittent and often related to exposure to specific allergens. You have ruled out most infectious culprits. The patient does not have symptoms or signs of TB, but some clinicians might run a purified protein derivative test anyway. Two other possibilities to consider are gastroesophageal reflux disease, with associated laryngopharyngeal reflux, and chronic fatigue syndrome.
—Walter N. Kernan, MD (100-6)