Fatal Emphysematous Tonsillopharyngitis With Laryngocele Involvement Revealing Acute Myeloid Leukemia M5 Subtype: A...

Emphysematous infections in the tonsillopharyngeal area are exceptionally unique; this type of infection occurs in immunocompromised patients. Extramedullary disease can occur in acute myeloid leukemia (AML), but oropharyngeal involvement is rare and diagnostically challenging. Furthermore, a laryngocele is defined as an abnormal dilation of the laryngeal saccule that is filled with air and fluid if infected. Although infections and cancers rarely extend to the laryngocele, they can be found in patients with laryngeal or hypopharyngeal cancer. We describe a 65-year-old male presenting with progressive sore throat, halitosis, and airway compromise. Contrast-enhanced computed tomography demonstrated bilateral emphysematous tonsillitis with parapharyngeal extension, severe supraglottic narrowing, and rare secondary involvement of a laryngocele. Histopathology demonstrated diffuse infiltrates of atypical mononuclear cells with a high nuclear-to-cytoplasmic ratio, irregular chromatin, and prominent nucleoli. Immunohistochemistry showed positivity for CD45, CD33, CD68, and MPO, confirming extramedullary AML-M5 infiltration of the tonsils. This case illustrates a rare radiologic and oncologic occurrence and the necessity for developing a high index of suspicion for identifying atypical sources of gas-forming infections in the head-and-neck area that may result from a malignancy; consequently, prompt diagnosis and intervention should take place.