229 Two Cases of Peritonsillar Abscesses With Predominant Eosinophilic Infiltrate. (11th January 2018)

• Record Type: Journal Article
• Authors: Straus, Jessica; Turi, George; Geller, Matthew
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S98
• Page End: S98
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx123.228
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Peritonsillar abscess formation with a marked predominance of an eosinophilic infiltrate has not been fully studied and is poorly understood. When a patient presents with what is believed to be a clear-cut case of a peritonsillar abscess, it would come as a surprise to the referring physician when the final report indicates an unconventional increase in the number of eosinophils relative to what is commonly encountered histologically in similar surgical specimen. In the setting of marked eosinophilia, a broad range of differential diagnoses must be taken into consideration. In the two patients being presented, the eosinophil counts were within normal limits, and neither patient had any significant medical history. In regards to the literature, not much is known as to what the significance of marked eosinophilia is in cases of acute and chronic inflammation within a peritonsillar abscess. In patients with peripheral eosinophilia, evaluation for parasitic infection, drug hypersensitivity, leukemia, non-hematologic cancer, asthma, and/or esophagitis should be considered. In both of our cases, each patient presented with odynophagia and dysphagia, amongst other symptoms specific to that patient and tonsillitis. Neither has any significant past medical history, and only one is known to have allergies (penicillin). At the time of presentation, both had elevated white blood cell counts and neutrophils. It was found during the operations that one patient's left tonsil had a tonsillar abscess with severe scarring and fibrosis, and the other patient's right tonsil had an abscess with gray-green purulent material. On review of the histology, both cases demonstrated acute and chronic inflammation with marked eosinophilia. The significance of marked eosinophilia in an otherwise healthy patient is a topic that has not been fully studied. Patients, as in those being presented, should have a clinical correlation and follow-up to rule out any of the above aforementioned differential diagnoses and whether their eosinophilia can predict the development of such disease entities.