Discussion
The diagnosis was
suspected to be Plaut-Vincent’s angina, which was subsequently confirmed
by the pharyngeal swab. After 10 days of treatment, the patient showed
complete healing.
This condition is a
painful infectious condition that primarily affects the interdental and
marginal gingiva, associated with monolateral ulcerative tonsillitis.
The ulcerative damage is caused by the presence of fusobacteria and
spirochetes, specifically Borrelia vincentii, in combination with
certain anaerobic bacteria1. Plaut-Vincent’s disease
primarily affects young individuals who experience stress,
immunosuppression, malnutrition, poor oral hygiene, and
smoke2.
These clinical signs
and symptoms typically resolve within a few days after appropriate
treatment and meticulous oral hygiene, but patients are still
susceptible to recurrences. Various authors stressed the importance of
swab and gram stain in suspected acute tonsillitis, where an inflamed
tonsil is covered by necrotic material
As a differential
diagnosis, in ulcerative tonsillar asymmetry,
diphtheria3, lymphoma4 and
oropharyngeal cancer5 should be considered. Therefore,
it is crucial to perform oropharyngeal swab and gram stain tests in
suspected cases, as symptoms typically resolve with proper treatment.
Conclusion
Plaut-Vincent’s disease
is an infectious condition that affects the gingiva and is associated
with monolateral ulcerative tonsillitis; it resolves with a targeted
antibiotic therapy. In tonsillar asymmetry, it is crucial to consider
differential diagnoses such as diphtheria, and oropharyngeal cancer. To
aid in diagnostic and therapeutic management, performing oropharyngeal
swab and gram stain tests is of utmost importance.
References
- Biswas D, Stafford N.
Borrelia tonsillitis: common symptoms but uncommon organism. Eur Arch
Otorhinolaryngol. 2010 Jun;267(6):989-90. doi:
10.1007/s00405-010-1229-8. Epub 2010 Mar 17. PMID: 20237790.
- Maccarrone F,
Alicandri-Ciufelli M. Plaut-Vincent’s Ulcerative Gingivitis and
Tonsillitis. Otolaryngol Head Neck Surg. 2019
Dec;161(6):1056-1057.doi:10.1177/0194599819868171. Epub 2019 Aug 6.
PMID: 31385752.
- Sharma K, Das S,
Goswami A. A Study on Acute Membranous Tonsillitis, Its Different
Etiologies and Its Clinical Presentation in a Tertiary Referral
Centre. Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl
3):4543-4548. doi: 10.1007/s12070-021-02572-2. Epub 2021 Apr 22. PMID:
33907680; PMCID: PMC8061714.
- Adil EA, Medina G,
Cunningham MJ. Differentiating Tonsil Cancer from Benign Tonsillar
Hypertrophy. J Pediatr. 2018 Jun;197:309-309.e1. doi:
10.1016/j.jpeds.2018.02.048. Epub 2018 Mar 28. PMID: 29605393.
- Gordis TM, Cagle JL,
Nguyen SA, Newman JG. Human Papillomavirus-Associated Oropharyngeal
Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis of
Clinical Trial Demographics. Cancers (Basel). 2022 Aug 22;14(16):4061.
doi: 10.3390/cancers14164061. PMID: 36011055; PMCID: PMC9406828.
Figures
Figure 1. Ulcerated
right tonsil