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
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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