Bilateral intratonsillar abscesses: A first case report in an adult patient

Abstract

Intratonsillar abscesses are not uncommon. The reported incidence of unilateral tonsillar abscess is 5 percent. There have not been any cases of bilateral tonsillar involvement previously reported. The clinical presentation of intratonsillar abscess are similar to peritonsillar abscess. Negative aspiration of pus from a case of intratonsillar abscess presumed to be peritonsillar abscess can lead to misdiagnosis and subsequent delay in treatment. We report a case of a 42-year-old diabetic patient with odynophagia, dysphagia, voice change, stridor and fever for a duration of four days. CT scan was performed in view of trismus and neck swelling as the initial provisional diagnosis of deep neck abscesses was made. The CT scan showed bilateral intratonsillar abscesses without involvement of other neck spaces. ‘Hot’ tonsillectomy was immediately performed after which the patient recovered well. Although uncommon, a high index of suspicion is required to diagnose intratonsillar abscess, especially in patient groups with high-risk factor e.g., diabetes mellitus with severe clinical complications.