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July 10, 2005
Peritonsillar cellulitis

 

Last Friday afternoon an older gentleman with Type 2 diabetes mellitus presented to the clinic with a one week history of a sore throat.  The patient described discomfort only on the right side and over the past two days he begun to notice a sense of fullness on that side.  Although his throat has been bothering he has been afebrile throughout this illness and never described any dysphagia.  Aside from the sore throat he hasn't any other symptoms of pharyngitis within the past two weeks.  On exam, his oropharynx was erythematous but no exudate was present.  Additionally the peritonsillar space was erythematous but not exudative or flucuant on palpation.  With this patient's physical findings and a history of a unilateral sore throat for a week I thought he had a small or early peritonsillar abscess but my attending corrected me and said this is more like a peritonsillar cellulitis.  Needlesss to say, I had never heard of such an animal so I wanted find out if there is a connection between cellulitis and abscess. 

Cellulitis is an infection of the skin with some extension into the subcutaneous tissues. While an extremity is the most common location, cellulitis can involve any area of the body.  In addition, cellulitis falls into a continuum of skin infections also including impetigo, folliculitis, carbuncles, and abscesses.  Well there you have it, cellulitis and abscesses are related pathologies where if cellulitis is left untreated, it could progress to an abscess.

In the case of this patient, since he probably had peritonsillar cellulitis, oral Augmentin was the therapy of choice.  Had he presented with a more fulminant infection of the peritonsillar space, incision and drainage of the abscess would be required and probable intravenous antibiotics.

 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12126026&query_hl=2
Posted At : 5:59 PM. | Link | Rotation 6 04-05 | Comments (6)

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Comments

Very interesting. I must admit I have not heard of such infection. I look into everyone's mouth and I have not yet seen a cellulitis or an abcess for that matter. To be honest I am not sure what I am even looking for. But I will keep this diagnosis in mind, especially siince I see about 4-5 sore throats a day.

Posted By Jeffrey Lawler / Posted At 7/12/05 9:07 AM

Most of the sore throats I've seen during FP have been oral candidiasis at the nursing home.

Posted By Susan Prater / Posted At 7/12/05 7:47 PM

Sounds like a cool case. I don't quite understand how you can tell celluitis from abscess from inspection/PE. I am also confused as to why he did not have a fever.. is it because it was not systemic. I really don't know anything.

Posted By Cormac Depan / Posted At 7/12/05 7:48 PM

Good post. THe patient I just saw had a peritonsilar abscess and his uvula was deviated away from the abscess. He had pain that went all the way to his ear and down his neck. I thought that an abscess was something that was walled off while cellulitis can extend... so maybe this guy had this peritonsillar cellulitis. hmmm I wonder if the ICD code is different for these 2 diagnoses ;)

Posted By Ann Ostrovsky / Posted At 7/13/05 3:47 PM

I've never seen one so i don't know much about it. but in the book, you're supposed to do a lateral x-ray of the neck to confirm the dx of peri. abcess or cellulitis? is it needed? did your attendant order one for your patient?

Posted By Minh Ho / Posted At 7/14/05 1:47 AM

Interesting. I have never heard of this. I have seen a few tonsilar abscesses, but never cellulitis. I shall now add this to my differential. Thanks.

Posted By Anne Suskind / Posted At 7/14/05 6:13 PM