A 19 Year old Male With Sore Throat And Unable To Eat

A 19 year old man presents to the emergency department with a 5 day history of a worsening sore throat. HE describes an increasing difficulty with eating because of throat pain and having a lump in the throat.He feels the pain becomes worse when trying to open his mouth. He says that he has had chills intermittently over the past few days and the temperature when he took at home was 102 F. He denies any nasal congestion, nausea, vomiting or diarrhea.

Physical Examination: reveals

• a moderately sick appearing individual
• mildly hoarse voice
• Oropharynx:  significant erythema with some streaky whitish material in posterior pharynx. Asymmetrical with uvular deviation to the right side and a focal area of swelling near the left palatine tonsil.
• Palpable lymphadenopathy in cervical nodes.
• Lung fields are clear on auscultation. 

The picture of the pharynx is shown below:

What is the Diagnosis?

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Peritonsillar Abscess.

Case Discussion:

Progression of bacterial tonsillitis causes a formation of an abscess in the peritonsillar or retropharyngeal spaces leading to a condition known as Peritonsillar abscess. 

Clinical Features:

• Sore throat.
• Difficulty opening the mouth.
• Hoarseness
• Fever with chills.
• Drooling.
• Significantly inflamed pharynx with uvular deviation on examination. 

Lab Work : Shows increased WBC count, positive rapid streptococccal antigen, positive throat culture.

Ultrasound may sometimes be helpful in locating the abscess and measuring its size. 

Treatment:

• Urgent Incision and drainage is performed unless the abscess is extremely small.
• Intravenous B- lactam or cephalosporin antibiotics.
• Elective tonsillectomy is to be planned after recovery to prevent recurrence.