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PLAUT-VINCENT ANGINA (Borrelia vincenti tonsillitis)

Article  in  Archives of Hellenic Medicine · January 2008

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Boboris Christos Panagiotis T Diamantopoulos

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John Meletis
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 Copyright © Athens Medical Society
Hematology Quiz - Case 1 www.mednet.gr/archives
261
ARCHIVES OF HELLENIC MEDICINE: ISSN 11-05-3992

CONTINUING MEDICAL EDUCATION

ARCHIVES OF HELLENIC MEDICINE 2008, 25(2):261
ΣΥΝΕΧΙΖΟΜΕΝΗ ΙΑΤΡΙΚΗ ΕΚΠΑΙΔΕΥΣΗ ÁÑ×ÅÉÁ ÅËËÇÍÉÊÇÓ ÉÁÔÑÉÊÇÓ 2008, 25(2):261
...............................................
C. Bomboris,
Internal Medicine Quiz – Case 6 S. Bouros,
G. Andreopoulos,
Y. Dalamagas,
A previously healthy 14-year-old female presented with a P. Diamantopoulos,
5-day history of a sore throat, fever, fatigue and cough. E. Variami,
K. Κοnstantopoulos,
Clinical examination revealed a slightly painful cervical
J. Meletis
lymphadenopathy, especially along the posterior cervical chain, ...............................................
slightly painful and pharyngitis. The complete blood count First Department of Internal Medicine,
showed: Ht 39%, Hb 13 g/dL, WBC: 9,000/μL (differential count: National and Kapodistrian University
neutrophils 14%, lymphocytes 72% and monocytes 14%). The of Athens, School of Medicine, “Laiko”
peripheral blood smear revealed the presence of atypical lym- General Hospital, Athens, Greece
phocytes. The laboratory examination revealed: ESR 30 mm/1
hour, CRP 22 mg/dL, AST 100 IU/L, ALT 150 IU/L, LDH 362 IU/L,
bilirubin 1.15 mg/dL, alkaline phosphatase 108 IU/L, γGT 352
IU/L, while the serum heterophile antibody was positive. The
Gram staining and culture of a throat swab was negative. The
patient was diagnosed with infectious mononucleosis and
treated symptomatically.

Five days later she presented with severe sore throat, dys-
phagia and halitosis. Clinical examination revealed unilateral
tonsillar ulceration and cervical lymphadenopathy. The com-
plete blood count showed leukocytosis 13,000/μL (differential
count: neutrophils 78%, lymphocytes 15%, monocytes 7%).
The peripheral blood smear revealed toxic granulation of the
neutrophils. A sample was taken from tonsillar ulceration and
the microbiology analysis was performed (fig. 1). The patient
was treated with clarithromycin. The symptoms and fever were
subsided after 5 days.

Comment
Vincent’s angina (Plaut-Vincent angina) is a disease caused by Figure 1
coinciding infections from Fusibacteria and Spirochaeta (obligate
anaerobic bacteria). It becomes evident on the mucous membranes
of the oral cavity and the oropharynx beside the tonsil. The clinical Corresponding author:
outcome may be different and pose difficulties in the differential C. Bomboris, First Department of Internal Medicine, National and
diagnosis. The specific staining is the most suitable procedure for Kapodistrian University of Athens, School of Medicine, “Laiko”
bacteria identification to support the clinical diagnosis of stomatitis General Hospital, GR-115 21 Athens, Greece
ulceromembranacea. e-mail: c.boboris@yahoo.gr

Diagnosis: Plaut-Vincent’s angina (Borrelia vincenti tonsillitis)

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