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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 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