A Rare Cause of Nonresponsive Tonsillitis in the Primary Care Setting: Acute Myeloid Leukemia
Turkiye Klinikleri J Case Rep. 2019;27(3):137-40
doi: 10.5336/caserep.2018-64138
Makale Dili: EN
Tam Metin
ABSTRACT
We present a 51year- old man with sore throat, headache, high fever, and weakness for two weeks. He had been diagnosed cryptic tonsillitis and given antibiotic treatment. Although he adhered to the therapy, he got worse. At the time of admittance he was weak and pale, pharynx, tonsils and buccal mucosa were hyperemic and inflamed, pus was present in tonsil area. The liver was extending about 5cm below the costal margin. He had substantial increase in leukocyte count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. He had lymphopenia, neutropenia and trombocytopenia. After suspicion of a hematologic malignancy, the patient was referred to the Department of Haematology and he was diagnosed with acute myeloid leukemia after bone marrow aspiration. We wanted to emphasize the importance of a detailed anamnesis and an extensive physical examination for nonresponsive tonsillitis in order not to overlook underlying pathologies such as leukemia in primary care.
Keywords: Primary health care; tonsillitis; leukemia myeloid acute
We present a 51year- old man with sore throat, headache, high fever, and weakness for two weeks. He had been diagnosed cryptic tonsillitis and given antibiotic treatment. Although he adhered to the therapy, he got worse. At the time of admittance he was weak and pale, pharynx, tonsils and buccal mucosa were hyperemic and inflamed, pus was present in tonsil area. The liver was extending about 5cm below the costal margin. He had substantial increase in leukocyte count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. He had lymphopenia, neutropenia and trombocytopenia. After suspicion of a hematologic malignancy, the patient was referred to the Department of Haematology and he was diagnosed with acute myeloid leukemia after bone marrow aspiration. We wanted to emphasize the importance of a detailed anamnesis and an extensive physical examination for nonresponsive tonsillitis in order not to overlook underlying pathologies such as leukemia in primary care.
Keywords: Primary health care; tonsillitis; leukemia myeloid acute
REFERANSLAR:
- Bisno AL. Acute pharyngitis. N Eng J Med. 2001;344(3):205-11. [Crossref] [PubMed]
- Worrall G, Huthsinson J, Sherman G, Griffiths J. Diagnosing streptococcal sore throats in aduts: randomized controlled trial of in-office aids. Can Fam Physician. 2007;53(4):666-71.
- Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999. JAMA. 2001;286(10):1181-6. [Crossref] [PubMed]
- Johnson BC, Alvi A. Cost effective workup for tonsillitis. Testing, treatment, and potential complications. Postgrad Med. 2003;113(3):115-8. [Crossref] [PubMed]
- Schwaab M, Gurr A, Hansen S, Minovi AM, Thomas JP, Sudhoff H, et al. Human beta-defensins in different states of diseases of the tonsilla palatina. Eur Arch Otorhinolaryngol. 2010;267(5):821-30. [Crossref] [PubMed]
- Touw-Otten FW, Johansen KS. Diagnosis, antibiotic treatment and outcome of tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries. Fam Pract. 1992;9(3):255-62. [Crossref] [PubMed]
- Worrall G. Acute sore throat. Can Fam Physician. 2011;57(7):791-4.
- Little P, Stuart B, Hobbs FD, Butler CC, Hay AD, Delaney B, et al. Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study. Lancet Infect Dis. 2014;14(3):213-9. [Crossref]
- Quinn J, Ruoff GE, Ziter PS. Efficacy and tolerability of 5-day, once-daily telithromycin compared with 10-day, twice-daily clarithromycin for the treatment of group A beta-hemolytic streptococcal tonsillitis/pharyngitis: a multicenter, randomized, double-blind, parallel-group study. Clin Ther. 2003;25(2):422-43. [Crossref]
- Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278(11):901-4. [Crossref] [PubMed]
- Şencan M. [Acute leukemias: epidemiology, etiology and pathogenesis]. Turkiye Klinikleri J Hem Onc-Special Topics. 2010;3(2):1-4.
- Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, et al; ESCMID Sore Throat Guideline Group. Guideline for the management of acute sore throat. Clin Microbial Infect. 2012;18 Suppl 1:1-28. [Crossref] [PubMed]
- Saultz JN, Garzon R. Acute myeloid leukemia: a concise review. J Clin Med. 2016;5(3):1-17. [Crossref] [PubMed] [PMC]
- Dechler B, Lübbert M. Acute myeloid leukemia: epidemiology and etiology. Cancer. 2006;107(9):2099-107. [Crossref] [PubMed]
- Özkalemkaş F, Özkocaman V, Özçelik T, Ozan Ü, Tunalı A. [Epidemiological characteristics of acute myelogenous leukemia in Southern Marmara Region of Turkiye]. Journal of Uludag University Medical Faculty. 2002;28(2):33-7.
- Davis AS, Viera AJ, Mead MD. Leukemia: an overview for primary care. Am Fam Physician. 2014;89(9):731-8.
- De Kouchkovsky I, Abdul-Hay M. 'Acute myeloid leukemia: a comprehensive review and 2016 update'. Blood Cancer J. 2016;6(7):e441. [Crossref] [PubMed] [PMC]
- Forman D, Stockton D, Møller H, Quinn M, Babb P, De Angelis R, et al. Cancer prevalence in the UK: results from the EUROPREVAL study. Ann Oncol. 2003;14(4): 648-54. [Crossref] [PubMed]
- Şencan İ, Keskinkılıç B. [2014]. Türkiye Kanser İstatistikleri. 1. Baskı. Ankara: T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu; 2017. p.16-40.
- Bain JB. The nature of leukaemia, cytology, cytochemistry and the morphological classification of acute leukaemia. Leukaemia Diagnosis. 5th ed. Hoboken NJ: John Wiley & Sons; 2017. p.1-68. [Crossref] [PMC]
.: İşlem Listesi