Spontaneous Tonsillar Hemorrhage in a Severe Acute Respiratory Syndrome Coronavirus 2 Positive Male

Abstract

Introduction Spontaneous Tonsillar Hemorrhage, also described as Hemorrhagic Tonsillitis , is a rare complication of acute or chronic tonsillitis with a reported incidence of less than 1.1% of all infectious tonsillitis cases worldwide Case Report A 19-year-old male with a history of chronic tonsillitis presented to the emergency department for a three-day history of progressively worsening odynophagia and blood-tinged saliva for greater than 48 hours, and found to have “kissing tonsils” on exam with bilateral exudates and venous oozing. Conclusion Emergent airway assessment is critical in patients presenting with potential airway obstruction. In patients presenting with spontaneous tonsillar hemorrhage, hemostasis should also be achieved, whether topically, or through emergent tonsillectomy should the patient’s clinical status warrant it.

Revisiting Tonsillectomy Practices in the Light of the COVID-19 Pandemic

“…It is defined as tonsillar bleeding for more than 1 hour or loss of 250ml blood, commonly caused by Haemophilus Influenzae, EBV and Beta Haemolytic Streptococci. Owing to the advent of antibiotics its incidence rate is only 1.1% amongst all cases of tonsillitis globally 34 . Infectious mononucleosis also causes huge tonsillar enlargement with edema of the pharynx, epiglottis, arytenoids and the uvula all of which causes fatal airway obstruction 35 .…”

“…Infectious mononucleosis also causes huge tonsillar enlargement with edema of the pharynx, epiglottis, arytenoids and the uvula all of which causes fatal airway obstruction 35 . Maintaining hemostasis and airway patency is vital to the initial management of such emergencies 34,35 . Silver nitrate is applied for chemical cauterization to stop bleeding followed by antibiotics to reduce inflammation 34 .…”

“…Maintaining hemostasis and airway patency is vital to the initial management of such emergencies 34,35 . Silver nitrate is applied for chemical cauterization to stop bleeding followed by antibiotics to reduce inflammation 34 . In cases of fatal airway obstruction, patients may present in critical states to the emergency departments requiring urgent tracheostomy and thyroidectomy to maintain airway patency 35 .…”

“…In cases of fatal airway obstruction, patients may present in critical states to the emergency departments requiring urgent tracheostomy and thyroidectomy to maintain airway patency 35 . An emergency tonsillectomy is often necessitated in such cases of uncontrollable bleeding or failure to maintain airway patency, presenting a dilemma of performing a high-exposure surgery and management on the airway of a possibly SARS-COV-2 positive patient 34,35 . Similarly, certain head and neck malignancies like tonsillar cancer when presents at an early stage, need to be resected without delay as deferring such surgeries worsen prognosis 8,19,20,32 .…”