MRCP2-0701

MRCP2-0701

A 32-year-old woman presents to the clinic. She has a 3-year history of rheumatoid arthritis, has been attending the hospital clinic for 8 months and is taking weekly methotrexate with folic acid coverage and diclofenac. For the past few days she has had a sore throat. On examination she is pale and looks fatigued; there are joint changes consistent with active lupus. There is clear evidence of severe pharyngitis. Abdominal examination is unremarkable.

Investigations:

Haemoglobin 90 g/l 120–160 g/l
White cell count (WCC) 1.2 × 109/l 4–11 × 109/l
Platelets 80 × 109/l 150–400 × 109/l

Which of the following diagnoses fits best with this clinical picture?