Concurrent peritonsillar abscess and poststreptococcal reactive arthritis complicating acute streptococcal tonsillitis in a young healthy adult: a case report

• Published in: BMC infectious diseases 2015-02, Vol.15 (1), p.50-50, Article 50
• Main Authors: Mazur, Elżbieta, Czerwińska, Ewa, Grochowalska, Aneta, Kozioł-Montewka, Maria
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Arthritis, Infectious; Arthritis, Reactive - diagnosis; Arthritis, Reactive - microbiology; Care and treatment; Case Report; Case studies; Diagnosis; Family medicine; Female; Health aspects; Humans; Infectious arthritis; Patient outcomes; Peritonsillar Abscess - diagnosis; Peritonsillar Abscess - microbiology; Pharyngitis - diagnosis; Pharyngitis - microbiology; Scarlet Fever - complications; Scarlet Fever - diagnosis; Streptococcal Infections - complications; Streptococcus pyogenes - isolation & purification
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-015-0780-8

Streptococcus pyogenes is responsible for 5-15% and 20-30% of acute pharyngitis/tonsillitis in adults and children, respectively. It not only causes acute illness but also can give rise to local suppurative complications such as peritonsillar abscess as well as trigger the postinfectious syndromes of glomerulonephritis, acute rheumatic fever and poststreptococcal reactive arthritis. Here, we report a case of a young healthy adult in whom both peritonsillar abscess and poststreptococcal reactive arthritis developed as a complication of acute streptococcal tonsillitis. To the best of our knowledge, such a coincidence of poststreptococcal sequelae has not been reported previously. A 32-year-old previously healthy woman was diagnosed with acute tonsillitis by her family doctor and treated empirically with amoxicillin/clavulanic acid (875/125 mg) twice daily for 5 days. Four days after completing antibiotic therapy, peritonsillar abscess of left tonsil developed. Needle aspiration followed by incision and drainage were performed by otolaryngologist at the Emergency Department. Next, the patient was discharged home on a 10-day course of cefuroxime and metronidazole. The symptoms of peritonsillar abscess were subsiding during treatment, however on the last day of antibiotic therapy, swelling and pain of the left ankle appeared. Five days later the patient was consulted by rheumatologist. Cultures of throat swabs and abscess aspirate collected 2 weeks before revealed the presence of Streptococcus pyogenes. Antistreptolysin O (ASO) titer was evaluated and proved to be 412 IU/ml (normal 0-200 IU/ml). The level of C-reactive protein was 13,0 mg/L (normal