A Rare Case of Intratonsillar Abscess in a Child: Diagnostic and Therapeutic Challenges.

Abstract

Intratonsillar abscess (ITA) is a rare infectious condition in both children and adults, with limited cases reported in the literature. It is often misdiagnosed due to its overlapping clinical features with peritonsillitis and peritonsillar abscess (PTA). Early recognition and appropriate management are crucial to prevent complications. We report a case of a 10-year-old boy with underlying allergic rhinitis and glucose-6-phosphate dehydrogenase (G6PD) deficiency who presented with a severe sore throat, fever, odynophagia, dysphagia, and right submandibular swelling. Examination revealed an asymmetrically enlarged right tonsil with trismus but no peritonsillar swelling. Laboratory findings showed elevated white blood cell count and C-reactive protein levels. A computed tomography (CT) scan confirmed a right intratonsillar hypodense lesion, suggestive of ITA. The patient was managed conservatively with intravenous antibiotics, analgesia, and hydration, resulting in clinical resolution without the need for surgical intervention. ITA shares clinical similarities with PTA, though trismus and voice changes are less frequent. While clinical examination is critical, imaging, particularly CT, is valuable in distinguishing ITA from other deep neck infections. Treatment primarily consists of intravenous antibiotics, needle aspiration and surgical interventions. Although rare, ITA should be considered in pediatric patients with persistent or severe tonsillitis symptoms. Prompt recognition and appropriate management, including the judicious use of imaging, can help avoid unnecessary surgical intervention while ensuring effective treatment.