Pharyngitis and Pharyngeal Space Infections

Domachowske, Joseph; Suryadevara, Manika

A 17-year-old female is seen in the emergency department with a 2-day history of fevers to 103 °F and a sore throat. Today, she describes her pain to be severe and mostly on the right side. She complains of difficulty opening her mouth and pain with swallowing. On examination, she appears anxious and uncomfortable, speaking softly with a muffled voice. Her oropharyngeal exam, although difficult to perform because of moderate trismus, reveals pharyngeal erythema, right pharyngeal wall swelling with deviation of her uvula to the left. Right neck swelling is also appreciated. A contrast-enhanced CT scan shows a peritonsillar abscess. Intravenous administration of ampicillin-sulbactam is initiated. An otolaryngology consult is obtained, and incision and drainage of the abscess is performed at the bedside. She is discharged home with oral amoxicillin-clavulanic acid for a total of 14 days. Bacterial cultures of the purulent material obtained grow Streptococcus anginosus, Prevotella sp., and non-typeable Haemophilus influenzae.