A 28 y.o. with a sore throat was sent from an outside hospital for peritonsillar abscess

What do you notice?

tonsils, mono.JPG

Our patient had tonsillar abscesses caused by mononucleosis.  These are to be differentiated from peritonsillar abscesses because they do not require drainage.

 Infectious mononucleosis is a viral infection caused by Ep[stein-Barr virus which presents with sore throat, lymphadenopathy and atypical lymphocytes in the peripheral blood.  Spontaneous resolution often takes 4-6 weeks.  Tonsillar abscesses may develop when infection from acute tonsillitis spreads into the the peritonsillar space or causes an abscess of Weber’s glands, which are minor salivary gland in the supratonsillar space.  1% of patients with mono develop peritonsillar abscesses. Most pertonsillar abscesses are bacterial often Strep.

 bilateral spontaneous tonsillar rupture in mono

bilateral spontaneous tonsillar rupture in mono

Clinically a peritonsillar abscess presents with trismus, soft palate deviation away from the infected side with uvular deviation and lymphadenopathy. The differential includes lymphoma, carcinoma of the soft palate and minor salivary gland tumors. Quinsy was the original term to describe a peritonsillar abscess.  It comes from the French word esquinacie.  

If peritonsillar abscesses are untreated they can lead to jugular vein thrombosis, cavernous sinus thrombosis, and dissection into the internal carotid artery.

 Our patient did not require drainage but did get antibiotics as prophylaxis for peritonsillar abscess. He was discharged on augmentin after three days.

 

 typical PTA

typical PTA

Fusano C, Chundnofsky C, Vanearbeek P. Bilateral peritonsillar abscess: not your usual sore throat. J Emerg Med. 2009 (29) 45-47.

Wadhera R, Kalra V, Gulati S, Ghai A. Infectious mononucleosis presenting with spontaneous rupture of bilateral quinsies. 2013 Egyptian Journal of Ear , Nose Throat and Allied Sciences. 14;45-46.

Flores C, Matthews M, Caruso D, Foster K, Stroschein M. A rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis. 2017 Otolaryngology Case Resports Volume 5; 1-5.

Mohamad I, Yroko A. Peritonsillar swelling is not always quinsy. 2013 Malaya Fam Physician 8(2): 53-55.