Case Presentation-Bilateral Peritonsillar Abscess

Case Presentation 1

00326480 강○영 ( F/18)

C.C.> sore throat onset) 1DA

P.I.>1) 최근 편도염으로 2 회 입원하신 Hx. 있는

분으로 , 인후통 및 열감을 주소로 내원하여 입원 .  

• PMHx.DM / HTN / Tbc( - / - / - )OPHx. ( - )Drug Hx ( + )

• SHx.Alcohol/smoking ( - / - )

Syetemic Review

Throat discomfort (-) sore throat (+) dyspnea (-)

dysphagia (-) odynophagia (-) voice change (-)    

H/L (-/-) otalgia (-/-) otorrhea (-/-)vertigo (-) tinnitus (-/-) earfullness (-/-)

     Nasal obstruction (-/-) rhinorrhea (-/-) PND (-) sneezing (-) snoring (-) hyposmia (-) anosmia (-)

Physical ExaminationN.C & nasopharynx ; DSN ( - ) Polyp (-) Discharge ( - ) Remaining ade-

noid

O.C & oropharynx : PI (-) PTH (+++/++++)Exudate (+), dirty gray color tonsils

Lx & hypophx. : TVC motility : both good Pyriform sinus : free Valleculae : free

Neck : Palpable neck mass (-)      -Tenderness (-)

• A>– r/o Peritonsillar abscess,both

• P> -I&D and culture-Lab-Pharynx ECT-Antibiotics-Pain control-Hydration

Lab

• WBC 15000• ESR 53, CRP 14.1• PBS :

– RBC: Normocytic normochromic– WBC: Slightly increased in number. Neutrophilia with toxic

granules and cytoplasmic vacuole– PLT: Normal in number

• Heterophil Ab(-)• Throat swap : Enterobacter cloacae• Pus culture : throat normal flora

Adm#3

• Sore throat persisted• Swelling of the soft palate with a midline

uvula pushed anteriorly.

Pharynx ECT Diffuse enlarged both palatine tonsil with peripheral rim enhanced cystic mass in both peritonsillar area (Rt: 2.5cm, Lt: 0.6cm) and multiple reactive LNs.      --> R/O Acute tonsillitis with peritonsillar abscess I&D culture

Adm#7D

• Sore throat(-), odynophagia(-+)• WBC; 5570

CRP(QN) 7.1 ▲ ESR 25 ▲

• Discharge

Discharge #7D

• Sore throat(-)• PTH(+++/+++)

Discharge #14D

• PI(+), PTH(+++/+++)• Rt ant pillar I&D site 로 pus dis-

charge• Adm 권유하였으나 refuse -short term f/u-antibiotics( cefdinir, clindamycin)

Discharge #17

• PTH(+++/+++)• no pus discharge• Mx 7days

Discharge #24

• Sore throat(-)• PTH(+++/+++)• No pus discharge• 개인사정으로 겨울 방학때 tonsillectomy

예정

Case Presentation 2

00215194 주○정 ( F/17)

C.C.> sore throat onset) 1WA

P.I.>1) 약 1 주일전부터 인후통있어 타병원에서

항생제 투약 후 증상 호전 없어 내원함 . 2) 월경과다

• PMHx.DM / HTN / Tbc( - / - / - )OPHx. ( + ) 2005 년 4 일 ASD direct suture

closure

Drug Hx ( + )

• SHx.Alcohol/smoking ( + / + )

Syetemic Review

Throat discomfort (-) sore throat (+) dyspnea (-)

dysphagia (-) odynophagia (-) voice change (-)    

H/L (-/-) otalgia (-/-) otorrhea (-/-)vertigo (-) tinnitus (-/-) earfullness (-/-)

     Nasal obstruction (-/-) rhinorrhea (-/-) PND (-) sneezing (-) snoring (-) hyposmia (-) anosmia (-)

Physical ExaminationTM : Rt. : free Lt. : free Valsalva ( + / + ) Weber test : ( no ) lateralization

N.C & nasopharynx ; DSN ( - ) Polyp (-) Discharge ( - )

O.C & oropharynx : PI (-) PTH (++++/++++) Exudate (+)

Lx & hypophx. : TVC motility : both good Pyriform sinus : free Valleculae : free

Neck : Palpable neck mass (-)      -Tenderness (-)

• A>– r/o Peritonsillar abscess,both– menorrhagia

• P> -I&D-Lab-Pharynx ECT-Antibiotics-Pain control-Hydration

• ◈4 Tiramox 주 1.2g 1via [IV side] i03    

• ◈5 Fullgram 주 600mg/4ml 1amp [Intra-Venous] i03  

I&D

• Rt peritonsillar abscess : anchovy like pus aspiration, I&D 했을때 bloody discharge gush out

• Lt peritonsillar abscess : small bloody aspiration , I&D 했을때 bloody dis-charge gush out

Lab

• WBC 6900• Hb 7.6• PBS : Slightly microcytic hypochromic

anemia with Anisopoikilocytosis• Heterophil Ab(-)

Pus study

• Gram stain : no bacteria seen• Anaerobe : no growth bacteria• Fungus : Candida albicans• AFB stain (-)• AFB culture : no growth of 6weeks