Peritonsillar abscess (Quinsy)
Complications of untreated group A β-hemolytic streptococcal (GABHS) infection include peritonsillar abscess (“quinsy”), poststreptococcal glomerulonephritis, and rheumatic fever. About half of patients with peritonsillar abscess present first with this complication rather than with pharyngitis. Among those who present first with sore throat and then develop peritonsillar abscess, only one quarter have GABHS pharyngitis. Patients who present first with sore throat, such as this patient, are distinguished by worsening sore throat despite antibiotic therapy, fever dysphagia, pooling of saliva, possible drooling, and muffled voice. On physical examination, the patient is ill-appearing and often has enlarged tonsils with deviation of the uvula to the unaffected side. The more serous complications include airway obstruction, dissection of the infection to the parapharyngeal space, spontaneous abscess drainage and aspiration of pus (usually while sleeping) and sepsis. Treatment consists of needle drainage or surgical incision and drainage of the abscess.