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appearance, high fever, stridor, and drooling. In every reported series of cases,
sore throat appears on the list of symptoms. Although this rarely may be the
primary complaint in a child, other more striking findings almost always
predominate. Epiglottitis should be easily excluded as a diagnosis in the patient
with a sore throat who is without stridor and appears relatively well.

Kawasaki Disease
Classic Kawasaki disease is characterized by a minimum of 5 days of high fever
along with at least four of the five following findings: (i) Bilateral bulbar
conjunctivitis, (ii) oral mucous membrane changes, (iii) peripheral extremity
changes (erythema and/or edema), (iv) polymorphous rash, and (v) cervical
adenopathy (see Chapter 101 Rheumatologic Emergencies ). The oral mucous
membrane changes most commonly involve the lips, but occasionally pharyngitis
may be a prominent feature. Other systemic inflammatory conditions (e.g.,
Behỗet syndrome) may involve the pharynx as well.

Stevens–Johnson Syndrome
Stevens–Johnson syndrome, a disease of unknown etiology but presumed to be
immune mediated, is characterized by vesicular and ulcerative lesions of the
mucosa, including the pharynx, the genitalia, and the conjunctivae ( e-Fig.
74.3A,B ). In addition, children with this condition may have a diffuse rash, often
characterized by target lesions or vesicles and bullae.

Chemical Exposure
Certain ingestions, such as paraquat and various alkalis, may produce a chemical
injury to the mucosa of the pharynx (see Chapter 102 Toxicologic Emergencies ).
Usually, these findings occur in the setting of a known ingestion and are
accompanied by lesions of the oral mucosa.

Referred Pain
Occasionally, pain from the inflammation of extrapharyngeal structures is

described as arising in the pharynx. Examples include dental abscesses, cervical
adenitis, and, occasionally, otitis media.

Psychogenic Pharyngitis
Some children who complain of a sore throat have no organic explanation for
their complaint after a thorough history and physical examination and a throat
culture. In these cases, the emergency clinician should consider the possibility of
anxiety, at times associated with frequent or difficult (globus hystericus )
swallowing.