Peritonsillar abscess of a newborn

We report a four-week-old boy who was assigned to us from an external children's clinic. There has been a history of fever for three days, a lack of head rotation to the left and a swelling in the left angle of the jaw. The patient had already received inpatient, antibiotic treatment and magnetic resonance imaging (MRI) by the external hospital. After telemedical presentation, the patient was transferred to us. Clinically, the mucous membranes and tonsils on both sides showed no irritation. In the left angle of the jaw impressed a palpable swelling. The MRI of the neck showed a pathological signal intensity in the peritonsillar region on the left with hypointense surrounding space and displacement of the pharynx to the right. There was an urgent suspicion of a PTA on the left. We continued weight-adjusted antibiotic therapy with ampicillin/sulbactam, pain therapy and lowering fever. The following day the operation took place without complications. An abscess was discharged at the lower tonsillar pole. Postoperatively, the patient was on pediatric intensive care unit for one night. Afterwards he could be transferred in good general condition on normal ward. The pathology findings showed a chronic granulating, florid inflammation, compatible with the diagnosis of PTA. Staphylococcus aureus was detected in the intraoperative wound swab. Due to the atypical constellation of age and diagnosis, further diagnostics regarding an immune deficiency were carried out. There was no reason for this. The aetiology of PTA is not sufficiently clarified. As in the present case, acute tonsillitis does not always have to be the starting point. A peritonsillar abscess can occur even in a newborn and the clinical findings can differ from that of an adult.

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Publication History

Article published online:
10 June 2020