A Unilateral Deep seated Peritonsillar Abscess in an Adult with Diabetic Ketoacidosis - A Case Report

Resumen

Background: Peritonsillar abscess (PTA) is the most common deep neck infection, typically arising as a complication of acute tonsillitis. While PTA is frequently encountered in otherwise healthy adults, its occurrence in the setting of diabetic ketoacidosis (DKA) is rare and poses unique diagnostic and therapeutic challenges. Case Presentation: We report the case of a 35‑year‑old male with poorly controlled type 2 diabetes mellitus who presented with severe sore throat, odynophagia, trismus, and muffled voice. Clinical examination revealed unilateral peritonsillar swelling with uvular deviation. Laboratory investigations confirmed DKA with hyperglycaemia, metabolic acidosis, and ketonemia. The patient was managed with intravenous antibiotics, insulin infusion, fluid and electrolyte correction, and incision and drainage of the abscess. Culture grew Streptococcus pyogenes. The patient improved rapidly and was discharged on oral antibiotics and optimized diabetic therapy. Discussion: This case highlights the bidirectional relationship between infection and metabolic crisis. Hyperglycaemia and acidosis impair host defenses, facilitating rapid progression of PTA, while the abscess itself exacerbates systemic illness. Previous reports have documented deep neck infections precipitating DKA, but PTA in this context remains uncommon. Prompt recognition and simultaneous surgical and metabolic management are essential to prevent airway compromise and systemic complications. Conclusion: Peritonsillar abscess in the setting of diabetic ketoacidosis is a rare but clinically significant scenario. Early diagnosis, incision and drainage, and aggressive metabolic correction are key to successful outcomes. Clinicians should maintain high suspicion for PTA in diabetic patients presenting with sore throat and systemic illness.