Hai suffered from recurrent tonsillitis. This time, he experienced a severe sore throat and was diagnosed with acute purulent tonsillitis, but medication proved ineffective. He developed a persistent high fever and retrosternal chest pain, prompting him to seek medical attention at Tam Anh General Hospital, Ho Chi Minh City.

Dr. Chau Tra Linh, from the ENT Center, performed an endoscopy, revealing congested tonsils on both sides and pus in the tonsil crypts. Suspecting cardiac dysfunction, the doctor ordered an electrocardiogram and blood tests to identify the cause of the retrosternal pain.

A cardiac MRI showed a moderate pericardial effusion with characteristics consistent with inflammatory exudate, though without signs of cardiac tamponade. Blood tests indicated elevated markers, suggesting myocardial damage. A chest CT scan identified areas of consolidation and ground-glass opacities at the base of both lungs, along with mild pleural effusion and partial passive collapse of the lower lobes of both lungs.

Doctors diagnosed Hai with acute purulent tonsillitis, pneumonia, myocarditis, pericarditis, polyserositis, and acute heart failure. He was admitted for intensive treatment, including antibiotics, cardiovascular support medication, and close monitoring.

Dr. Tra Linh performing a throat endoscopy on Hai during a follow-up examination. *Photo: Tam Anh General Hospital*

Hai had no history of hypertension or other cardiovascular diseases. Based on clinical and subclinical assessments, the medical team determined that the infection originating from the acute purulent tonsillitis triggered a systemic inflammatory response, leading to cardiovascular complications. "Myocarditis, pericarditis, and acute heart failure are serious complications of tonsillitis, especially in young patients without pre-existing risk factors," Dr. Linh stated.

Acute tonsillitis is typically caused by bacteria or viruses. Most cases are benign and respond well to treatment. However, if the infection is not controlled, bacteria and the inflammatory response can spread, causing local complications such as peritonsillar abscesses or lateral pharyngeal abscesses, and systemic complications like pneumonia, myocarditis, and damage to other organs. The risk is higher in elderly individuals and those with chronic conditions such as diabetes or weakened immune systems.

After more than one week of treatment, Hai's condition improved significantly. His white blood cell count and C-reactive protein levels gradually decreased, showing a good response to the treatment regimen. He was advised to schedule a follow-up appointment.

Dr. Linh advised individuals with tonsillitis to seek timely examination and treatment. If symptoms such as persistent fever, worsening sore throat, difficulty swallowing, difficulty breathing, or other unusual symptoms like chest pain or palpitations appear, patients should go to a medical facility for assessment and appropriate treatment to avoid serious complications.

Uyen Trinh

*Patient's name has been changed