A 28-year-old man arrives at the emergency department complaining of a sore throat. The pain has been increasing over the last few days and he is now finding it difficult to open his mouth. He has stopped eating and is only tolerating small amounts of fluid. Two days ago he saw his general practitioner, who prescribed him some oral antibiotics and analgesia for a mild tonsillitis. He suffers from asthma.
Examination He appears uncomfortable and has difficulty in speaking as a result of his pain. His blood pressure is stable, but his temperature is 39.0°C and his pulse rate is 115/min. His oxygen saturation is 98 % on room air. An oral examination, with a tongue depressor, is difficult due to trismus, but reveals a unilateral left-sided tonsillar swelling with a diffuse oedematous ‘bulge’ superior and lateral to the tonsil. As a result, the uvula is deviated to the contralateral side.…
