ABSTRACT
A 22-year-old man presented to the emergency department complaining of a painful throat and swelling of the glands in his neck. He described a 5-day history of worsening odynophagia, fever and coryzal symptoms. He had visited his general practitioner and received a course of penicillin V 3 days earlier, but his symptoms had not improved. The odynophagia had become increasingly severe and he was now unable to swallow soft food. He felt nauseated and complained of malaise. He had no rash and denied symptoms of headache or photophobia. He had noticed cervical lymphadenopathy since the onset of his illness, predominantly affecting the left-side of his neck. His past medical history included three episodes of tonsillitis, each approximately 1 year apart. He took no regular medications aside from the recently prescribed penicillin V. He lived with his parents and sister, all of whom were well. He worked as an office clerk and had not travelled abroad for 2 years. He had never smoked tobacco and drank around 20 units of alcohol per week. He used both cocaine and marijuana at weekends.
