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Pain, sorethroat with bilateral LEVEL-IB,II NODES in USG. Reason?

Resolved Question:

I'm a 27 year old female from Bangalore, India and have had multiple symptoms over the past two months

Ear Pain - Mid June - Mid July 2014, September 2014 - Present
Sore Throat, Throat Pain - September 2014 - Present
Fever every evening (after 4pm) - 99F - 99.6F - October 1st 2014 - Present
Neck Stiffness and Pain (Scale 7.5/10) - September 19th - Present
Cough with metallic taste and a little mucus- October 1st 2014 - Present. Was extremely violent, but has started to recede in the past couple of days.
Nausea - Past week
Underarm Pain - Past few days
Severe Fatigue (comes and goes)

- Fiberoptic Laryngoscopy (LPRD Grade II/III, Allergic Rhinitis) (October 23rd)
- Ultrasound Neck (September 17th)
Bilateral level IB and level II nodes are seen (right > left side), largest node on the right side measuring 1.1cms. Nodes are discrete and show preserved hilar fat.
Small upper cervical nodes - probably nonspecific
Normal thyroid morphology
- CBC (October 19th, attached)

Medication taken
Ceftum 250 g 1-0-1 x 5 days
Powergesic 1-0-1 x 3 days

Other issues:
B12 Deficiency, Vitamin D

What could it possibly be?

Category: ENT Specialist

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Category: ENT Specialist
 25 Doctors Online

Thank you for your query at

You are suffering from ear pain, sore throat, throat pain, mild fever for almost 2 months.

Your laryngeal endoscopy shows lpr( reflux). Your cbc- normal, usg neck- nonspecific.

Now bodyache for2-3 days, can be viral infection

You can be evualated further including throat swab to rule out throat infection.

Chest xray , ESR can be done for evaluation of cough. Though cough may be due to lpr.

Start treatment for lpr including Tab. Rabeprazole 20 mg one in morning for one month.

Hope this helps,
Feel free to discuss further,

Best regards,

Dr. Sunil Jalan

Patient replied :

Thank you for your reply.
ESR was already done. It was in the previously attached file. If cough is due to LPR, why would I get fever for almost a month, and that too every evening after 4pm?


Your ESR was 14 which is normal. Small change in temp may be due to diurnal variation. If you are getting fever it need to be evualated further, lpr will not cause fever. I don't was to write list of possible diagnosis because it will cause unnecessary fear. We can do step by step investigations to get correct diagnosis, by getting consultation with local physician.

1st you can plan for chest xray, sputum afb.

Hope this helps

Best regards

Dr. Sunil Jalan

Patient replied :

Hi Doctor,
Please find attached the chest x-ray report. Please let me know how to proceed now.


Your chest x ray suggests bronchitis, needs clinical examination by a physician to confirm it and can be treated with course of antibiotic.

Following medicine can be taken after the examination with consultation :

Augmentin 625 mg two times for 5 days

Syr. Brozedex 10 ml two times for 5 days

Tab. Montair-LC one in night for 5 days

Hope this helps

Best regards

Dr. Sunil Jalan

Patient replied :

Hi Doctor,
I showed a pulmonologist today and he said the chest xray is clear. There is no bronchitis. I have attached a more detailed record of my fever / medication chart. Please advice how to proceed.

Thank You for the follow up.
Your pulmonologist, is the best judge of whether you have bronchitis or not. If he ruled it out, then definitely it is not there. I have reviewed your reports too.
However i suggest you get a sputum AFB done and then get back to me.
Meanwhile take the following medicines,
1) Tab. Augmentin 625 mg twice daily for 5 days.
2) Syp. Brozedex 10 ml twice daily for 5 days.
3) Tab. Montair LC once in the night time for 5 days.

Dr. Sunil Jalan
Category: ENT Specialist
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
Dr. Sunil Jalan and 4 other Medical Specialists are ready to help you

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