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A 52-year-old woman was admitted with malaise and leg weakness. Her illness started with a sore throat while travelling in Eastern Europe. On examination she was febrile (39.1°C) with several areas of exudates on her pharynx and extensive cervical lymphadenopathy. There was weakness of the legs with absent tendon reflexes.

What is the most likely diagnosis?

1) Acute myeloid leukaemia.

2) Cytomegalovirus infection.

3) Diphtheria.

4) Glandular fever.

5) Streptococcal tonsillitis.


3) Diphtheria.


Yeah, me thinks too!


3) agreed




This history of severe exudative pharyngitis in a person who has recently traveled to Eastern Europe is highly suggestive of diphtheria. The disease, caused by Corynebacterium diphtheriae, causes a severe pharyngitis with extensive soft tissue swelling and lymphadenitis that produces a characteristic 'bull neck' appearance.

Exotoxins produced by the organism may cause myocarditis or neurological defects. The degree of neurological toxicity varies, but may be severe, causing cranial neuropathies, predominantly motor peripheral neuropathy (occasionally sensory neuropathy). An epidemic of diphtheria began in Russia in the early 1990s and remains a significant public health problem in Russia and in the former Soviet states.

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