Rare case of necrotizing tonsillitis causing severe airway infection in an infant: a case report

• DOI: 10.1186/s13052-025-01969-x
• Publication Date: 2025-04-23T16:52:16Z
• Authors: Farah Hanim Abdullah; Yi Xuan Low; Rufinah Teo; Mohd Imree Azmi; Mohammad Nizam Mo...; Izzuddin Azaharuddin; Azarinah Izaham

Necrotizing tonsillitis is rare and may lead to life-threatening upper airway obstruction in children, requiring emergency management. An 8-month-old boy presented with unresolved fever was diagnosed acute tonsillitis. Despite prior treatment amoxicillin paracetamol, the persisted, accompanied by leukopenia. Intravenous C-penicillin initiated, but respiratory distress ensued, necessitating non-invasive ventilatory support subsequent intubation due increased stridor. Intubation challenging copious secretions a floppy epiglottis, successful achieved on second attempt using C-MAC® video laryngoscope Miller blade size 0. Computed tomography (CT) revealed large collection mucosal involvement peritonsillar tonsillar regions, extending adjacent structures. Direct laryngoscopy, tissue sampling, multiple surgical debridements were performed as patient's condition deteriorated. Perianal excoriation diarrhea raised suspicion of primary immunodeficiency syndrome. Pseudomonas aeruginosa Stenotrophomonas maltophilia isolated from cultures effectively treated targeted antibiotics. Serological testing showed positive IgG for herpes simplex virus 1 (HSV-1), while immune deficiency indicated normal status, pending genetic results. After 21 days ventilation, patient extubated, received support, discharged oral This case highlights critical nature necrotizing tonsillitis, especially infants suspected immunosuppressive disorders. Early recognition, prompt management, intervention are crucial optimal outcomes.