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A 17-Year-Old Girl Is Brought to the Office Due to a 14-Day

question 714

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A 17-year-old girl is brought to the office due to a 14-day history of fever, neck "lumps," sore throat, and malaise.  She has severe fatigue and has not been able to attend classes.  She also has had difficulty swallowing because of throat pain.  The patient has no cough, abdominal pain, nausea, or vomiting.  She has no chronic medical conditions.  Temperature is 38.7 C (101.7 F) , blood pressure is 120/76 mm Hg, pulse is 86/min, and respirations are 24/min.  Physical examination shows an uncomfortable patient who is breathing loudly through the mouth.  There are no oral lesions.  Tonsils are erythematous and markedly enlarged with bilateral exudates.  Multiple tender, mobile, posterior cervical lymph nodes are palpable.  Heart sounds are normal without murmurs.  Lungs are clear without wheezing or rales.  The abdomen is soft and nontender; the spleen is palpable 2 cm below the left costal margin.  Which of the following complications is this patient most at risk for developing?


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