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\begin{document}

\title{Monolateral ulcerative tonsillitis in a young male}



\author[1]{Serena Jiang}%
\author[2]{O. Gallo}%
\affil[1]{Università degli Studi di Firenze}%
\affil[2]{University Hospital Careggi}%


\vspace{-1em}



  
  \date{May 29, 2024}


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\selectlanguage{english}
\begin{abstract}
A 24-year-old man presented with fever, throat pain, and diffuse
myalgia. Examination revealed an ulcerated right tonsil, twice the size
of the contralateral one, which showed no signs of inflammation. No
trismus or abscess were observed, and airway obstruction was ruled out
with fiberendoscopy. Blood tests showed an elevated white blood%
\end{abstract}%



\sloppy


\textbf{Title: ``Monolateral ulcerative tonsillitis in a young male''}

Monolateral ulcerative tonsil in a male

Authors: Serena Jiang, MD\textsuperscript{1,*}; Oreste Gallo,
MD\textsuperscript{1}.

\textsuperscript{\textbf{1}} Department of Otorhinolaryngology, Careggi
University Hospital, Largo Brambilla 3, 50134, Florence, Italy.

\textsuperscript{*} Corresponding author: Serena Jiang, MD, Department
of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3
- 50134 Florence, Italy. +390557947989, serena.jiang@unifi.it ORCiD:
0000-0002-7162-3657

Keywords: tonsillitis; differential diagnosis; Plaut Vincent

CREDIT CONTRIBUTIONS

Jiang: data curation, formal analysis, investigation, methodology,
validation, visualization and writing - original draft. Gallo:
Conceptualization, project administration, resources, supervision,
review and editing. All authors read and approved the final version of
the manuscript.

ORCiD: Serena Jiang 0000-0002-7162-3657, Oreste Gallo
0000-0003-3426-717.

Consent statement: written informed consent was obtained from the
patient to publish this report in accordance with the journal's patient
consent policy''

Conflict of Interest Disclosures: None reported.

Funding: None.

This manuscript is approved by the review board of Careggi University
Hospital.

The patient gives his permission for the following material to appear in
the print, online, and licensed versions of Otolaryngology-Head and Neck
Surgery.

Word count: 335

\textbf{Case report}

A 24-year-old male patient presented with fever (38.5\selectlanguage{ngerman}°C), throat pain,
headache, and diffuse myalgia over the course of the last few days.
Examination of the oral cavity revealed an ulcerated right tonsil that
appeared twice the size of the contralateral tonsil, which was cryptic
but showed no signs of inflammation (figure 1). No trismus or signs of
abscess were observed, and flexible fiberendoscopy ruled out airway
obstruction. Blood tests showed an elevated white blood cell count, and
the monospot test for infectious mononucleosis was negative.

Initial treatment included regular analgesia, chlorhexidine mouthwash,
and empirical antibiotic therapy. After 10 days, the patient fully
recovered.

\textbf{Discussion}

\par\null

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 bacteria\textsuperscript{1}.
Plaut-Vincent's disease primarily affects young individuals who
experience stress, immunosuppression, malnutrition, poor oral hygiene,
and smoke\textsuperscript{2}.

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,
diphtheria\textsuperscript{3}, lymphoma\textsuperscript{4} and
oropharyngeal cancer\textsuperscript{5} 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.

\par\null

\textbf{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.

\textbf{References}

\par\null

\begin{enumerate}
\tightlist
\item
  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.
\item
  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.
\item
  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.
\item
  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.
\item
  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.
\end{enumerate}

\textbf{Figures}

\par\null

Figure 1. Ulcerated right tonsil\selectlanguage{english}
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