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A 16-year-old girl presented with fatigue,
weight loss, and dysphagia that began several
months earlier. She had restless sleep lead-
ing to daytime somnolence and poor school
performance, and her family reported loud
snoring. Her medical history was unremark-able, except for
recurrent upper respiratory
tract infections.
Physical examination revealed noisy res-
pirations with an open mouth, halitosis, and
tonsillar swelling (see accompanying figure).
She had no fever or lymphadenopathy.
Question
Based on the patients history and physical
examination, which one of the following is
the most likely diagnosis?
A. Bilateral tonsillar abscesses.
B. Hypertrophic tonsils. C. Infectious mononucleosis. D. Tonsill
itis.
See the following page for discussion.
Enlarged Tonsils and FatigueMALCOLM LEMYZE, MD, and FAVORY
RAPHAEL, MD, Calmette Hospital, Lille, France
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