The URI That Won't Go Away: Case Challenge

Itzhak Brook, MD, MSc

Disclosures

October 28, 2013

A Teen With Persistent Runny Nose, Sneezing, Sore Throat

A 17-year-old girl presented to her primary care provider on a winter morning with a 5-day exacerbation of runny nose, sneezing, and sore throat. These symptoms had begun over 3 months earlier and had since persisted, with varying degrees of severity. She had been treated with 2 courses of antimicrobial agents (azithromycin for 5 days and amoxicillin for 7 days), decongestants, and cough suppressive therapy. Her symptoms subsided with therapy but did not resolve.

Her medical history consisted of episodes of streptococcal tonsillitis at age 7 and 8 years and occasional colds, but she was otherwise healthy. She had received all childhood vaccines and has no history of allergy. The current exacerbation started as a cold with runny nose, frontal headache, a sense of malaise, and fever of 101.2°F that lasted approximately 24 hours.

On presentation, the patient appeared ill, with a runny nose and constant cough. Her temperature was 98.6°F. Examination revealed bilateral mucoid nasal discharge, pharyngeal redness, enlarged tonsils, fluid behind the right eardrum without redness, and minimal cervical lymphadenitis. She had no tenderness on percussion or pressure on the cheekbones or frontal bones. The rest of the physical and neurologic examination was normal.

The teen was diagnosed with sinusitis.

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