A patient presented with 2 days history of fever. On examination there was a swelling in the neck and one side tonsil was pushed to midline. What is the most likely diagnosis:-
**Core Concept:**
The question is based on the clinical presentation of a patient with fever and cervical lymphadenopathy along with tonsillar enlargement. The correct diagnosis should involve understanding the clinical signs and symptoms, particularly the description of tonsillar enlargement and cervical lymphadenopathy.
**Why the Correct Answer is Right:**
In this case, the correct diagnosis is **Submandibular Gland Mumps** (also known as Mumps Orchitis). Mumps is a viral infection primarily caused by the Mumps virus (Paramyxovirus), which primarily affects the salivary glands, particularly the submandibular glands. The clinical presentation includes fever, cervical lymphadenopathy, and enlargement of the submandibular glands.
In this scenario, the tonsillar enlargement and lateralization to the midline are due to the involvement of the submandibular glands. The swelling in the neck is caused by the lymphadenopathy.
**Why Each Wrong Option is Incorrect:**
A. **Rheumatic Fever (RF)**: RF is a misdiagnosis, as it primarily affects the heart, joints, and brain, and does not present with tonsillar enlargement and lateralization to the midline. RF is characterized by fever, arthralgia, and heart murmurs.
B. **Infectious Mononucleosis (IM) or Infectious Diseases**: This is a misdiagnosis, as IM is primarily characterized by fever, adenopathy, and hepatosplenomegaly, while tonsillar enlargement and lateralization are not typical features of IM. IM is caused by the Epstein-Barr virus and typically presents with a "kissing disease" appearance due to enlarged tonsils and adenoids.
C. **Infectious Lymphadenitis**: This is a misdiagnosis, as it does not explain the tonsillar enlargement and lateralization to the midline. Infectious lymphadenitis is characterized by generalized lymphadenopathy and fever, not tonsillar enlargement and lateralization.
D. **Submandibular Gland Mumps**: Although mumps can affect the submandibular glands, the correct diagnosis is submandibular glands because it does not explain the tonsillar enlargement and lateralization to the midline. Additionally, submandibular gland mumps typically presents with bilateral swelling and pain in the submandibular region, not tonsillar enlargement and lateralization.
**Clinical Pearl:** Mumps is an important differential diagnosis to consider in cases of unilateral swelling of the salivary glands, especially when associated with fever and lymphadenopathy.
**Correct Answer:** **Submandibular Gland Mumps**: The correct diagnosis explains the tonsillar enlargement and lateralization to the midline, which is not typical for mumps affecting the submandibular glands. Submandibular gland mumps typically presents with bilateral swelling and pain in the submandibular region, not tonsillar enlargement and lateralization to the midline.
**Why the Other Options are Incorrect:**
A. Submandibular gland mumps does not explain the tonsillar enlargement and lateralization