Question

You have a patient who is positive for strep on rapid antigen testing. You order amoxicillin after checking for drug allergies (pt has none) but he returns 3 days later, reporting that his temp has gone up, not down (101.5 in office). You also note significant adenopathy, most notably in the posterior and anterior cervical chains, some hepatomegaly, and a diffuse rash. You decide:

Answer 1

The patient's worsening condition after treatment for strep throat with amoxicillin may indicate an alternative diagnosis or complicated infection, such as infectious mononucleosis or acute rheumatic fever. Considering the limited resistance of Streptococcus pyogenes to penicillin, a thorough re-evaluation and additional testing are advised to guide further treatment.

Step-by-step explanation:

The patient presenting with a fever, significant adenopathy, hepatomegaly, and diffuse rash after a positive rapid antigen test for strep throat and a subsequent course of amoxicillin suggests a possible alternative diagnosis or a complicated streptococcal infection. The symptoms could be indicative of a more serious condition, such as infectious mononucleosis, which is characterized by severe lymphadenopathy and hepatomegaly, or acute rheumatic fever, a sequela of untreated or inadequately treated streptococcal pharyngitis with symptoms including rash and fever.

Considering the microbial susceptibility of Streptococcus pyogenes to penicillin-based antibiotics like amoxicillin, and noting that antibiotic resistance is generally limited for this bacterium, the persistence and worsening of symptoms may warrant further investigation including a thorough re-evaluation of the patient, additional laboratory tests, and possibly a change in the antibiotic regimen. Following an alternative diagnosis, a different treatment plan may be necessary, which could include a different class of antibiotics or supportive care depending on the exact diagnosis.