Acute Necrotizing Herpetic Tonsillitis: A Report of Two Cases

Abstract

The finding of herpetic tonsillitis is rare. Tonsillectomies are usually done for children with recurrent chronic tonsillitis, while viral throat infections are generally self-limiting. We present two cases: A 5 yearold girl, with atypical hemolytic anemia managed with Eculizumab, who presented with a pharyngeal infection and tonsillar enlargement that did not respond to intravenous antibiotics or antifungal therapies; and a 30 yearold man who presented with upper airway obstruction and fever; bilateral tonsillectomies were performed. Histopathological examination showed a necrotizing tonsillitis with numerous ground-glass intranuclear inclusions, characteristic of herpes viral infection, further confirmed by Herpes simplex virus in situ hybridization. Both patients were managed by intravenous Acyclovir, with dramatic improvement.

ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Soluble immune effector molecules [II]: agents targeting interleukins, immunoglobulins and complement factors)

“…There is growing evidence suggesting the contribution of the complement system to T-cell regulation [262]. In agreement with this, herpes simplex virus-1 infection (in form of acute necrotizing herpetic tonsillitis) and respiratory tract viral syndromes have been observed with eculizumab [204,263]. The recent report of a multivisceral transplant recipient treated with eculizumab for 12 months due to aHUS and subsequently diagnosed with progressive multifocal leucoencephalopathy raises the possibility that the blockade of MAC formation might increase susceptibility to this complication.…”

Chronic tonsillitis and biofilms: a brief overview of treatment modalities

“… 16 – 19 The Dutch scientist (commonly known as the Father of Microbiology) Antonie van Leeuwenhoek used his primitive but effective microscope to observe biofilms as early as 1674 and described aggregates of animalcules scraped from human tooth surfaces. 20 , 21 The English phrase “survival of the fittest” arose from Darwinian evolutionary theory and describes one of the mechanisms of natural selection. 22 , 23 Bacterial biofilm formation is a form of “survival of the fittest” under adverse conditions including chemical or antimicrobial treatment.…”

Acute Herpetic Nasopharyngitis in an Adult Patient: A Case Report and Literature Review

“…Only 2 herpetic tonsillitis cases, 3 herpetic pharyngitis cases, and 1 herpetic laryngitis case in adults have been reported. [7][8][9][10][11] We report the first case of herpetic nasopharyngitis. It is worth noting that in all of these cases, the onset was gradual.…”