Abstract

Background: Suppurative tonsillitis is mainly caused by β-hemolytic streptococcal infection, staphylococcal infection, and Streptococcus pneumoniae infection. The presentations include general discomfort, shivering, fever, and muscle soreness of limbs. Physical examination shows pharyngeal congestion, tonsil reddening and swelling, and purulent exudate on the surface of tonsils. However, only a few case reports about suppurative tonsillitis caused by community-acquired MRSA infection have been published to date. This was a case report of suppurative tonsillitis caused by suspected MRSA infection, which could provide valuable evidence in guiding the treatment of such diseases.

Case presentation: A 36-year-old male from Heilongjiang Province (China) was admitted to the Respiratory Department in Zhejiang Hospital of Traditional Chinese Medicine for fever and pharyngalgia for 2 days. The patient had a history of tonsil infection, and received irregular penicillin treatment. The response of the patient to cephalosporins, penicillins, and carbapenems was generally suboptimal, and indicators of inflammation, including blood routine examination results, CRP, and PCT, were evidently elevated. Anti-MRSA therapy was continued for 1 week, which effectively alleviated the symptoms. As the risk of repeated tonsil infection could be relatively high, the patient received tonsillectomy in the Department of Otolaryngology.

Conclusions: For patients with suppurative tonsillitis who do not respond to conventional anti-inflammation therapy, the possibility of MRSA infection should be considered if the inflammation indicators increase continuously. Repeated throat swab smear examinations and blood culture can provide evidence to guide diagnosis. Aggressive systemic anti-infective treatments were performed for the present case, which effectively controlled systemic inflammatory reactions and prevented septicopyemia. Moreover, it laid foundations for further radical treatment.

Keywords: Suppurative tonsillitis; Community acquired methicillin resistant; Staphylococcus aureus ; Teicoplanin; Tonsillectomy