Spontaneous Rupture of a Peritonsillar Abscess Mimicking Successful Incision and Drainage: A Case Report

Peritonsillar abscess (PTA) is a common deep infection of the head and neck that can present with significant clinical symptoms. Patients typically present with fever, malaise, sore throat, otalgia, dysphagia, and the characteristic muffled "hot-potato" voice. Although PTA is generally managed effectively with antibiotics, analgesics, and abscess drainage, spontaneous rupture is uncommon and may falsely suggest clinical resolution, posing a diagnostic and management challenge. We present the case of a 25-year-old woman who presented with a five-day history of sore throat, fever, odynophagia, dysphagia, hot-potato voice, and foul taste in the mouth. Examination revealed right peritonsillar swelling with a mucosal opening consistent with spontaneous rupture of the abscess. The rupture was presumed to have occurred prior to presentation and was further supported by the patient's history of a sudden onset of a foul taste around the third day of symptoms, followed by partial symptomatic relief. Laboratory investigations demonstrated significant inflammation, with a C-reactive protein (CRP) level of 190 mg/L and neutrophilic leukocytosis. The patient was admitted for intravenous antibiotics, dexamethasone, and observation; however, she requested discharge against medical advice one day after admission due to reported symptomatic improvement and travel plans. Spontaneous rupture of a peritonsillar abscess is a rare event that may lead to transient symptom relief and a misleading impression of recovery due to possible incomplete drainage. This case highlights the importance of careful clinical evaluation and continued management despite apparent improvement, as persistent infection and complications may still occur.