Lingual tonsillitis and sepsis: a case report
Lingual tonsillitis is a rare inflammatory disease which might be life-threatening. We present a case of 55-year-old woman complaining of high fever, sore throat, dysphagia and swelling of the neck. Her past medical history included palatine tonsillectomy in childhood. On admission the patient looked pale with a blood pressure of 140/80 mmHg. Her skin was hot to the touch and she had a temperature of 38,6 degree Celsius. Auscultation of the lungs was normal. The physical examination revealed a swollen neck, tender on palpitation, the movements of the neck were restricted due to the pain. Posterior pharyngeal wall was not inflamed. Laboratory test revealed leukopenia of 0,4x10e9/l, neutropenia of 0,16x10e9/l, thrombocitopenia of 13x10e9/l, CRP of 266,1 mg/l, procalcitonin of 24 mcg/l. Urine test was inconclusive. The chest radiograph was normal. Ultrasound of the neck showed multiple enlarged lymph nodes up to 10 mm. It was decided to perform an indirect laryngoscopy, which revealed an enlarged and ulcerated lingual tonsil with small necrotic lesions. Clinical diagnosis of sepsis, purulent lingual tonsillitis, agranulocytosis and pseudothrombocytopenia was made. The patient received antibiotics as well as granulocyte-colony stimulating therapy. The patient’s response to treatment was good with the prediction of full recovery. Performing an incomplete oropharyngeal examination could lead to missing the location of an infection.
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