Clinical Challenge: Spots on Throat

History of Present Illness

A woman in her mid-20s presents to the emergency department (ED) with a 2-day history of sore throat and fever (102.9 ⁰F). She denies having symptoms of cough, shortness of breath, or other complaints. The patient is otherwise healthy and has no chronic medical problems.

Vital Signs and Physical Examination

The patient’s vital signs are normal except for a temperature of 99.9 ⁰F. Physical examination is normal except for a slightly dysphonic voice. On physical examination, the patient’s throat shows palatal petechiae and bilateral tonsillar exudates that are worse on the right side (Figure).