Granulomatous Tonsillitis

Abstract

Seven patients with symptoms of chronic recurrent tonsillitis showed granulomatous reactions histologically in the resected specimens. There was nothing unusual about the preoperative clinical course or gross features of the tonsils. Given the usual clinical circumstances attending chronic tonsillitis, cultures were only sporadically done. No direct cultures of resected tissue were done. Special stain tests for acid-fast organisms and fungus, admittedly unreliable in the detection of their respective diseases, were negative. Five patients were followed 1-5 years and had no adverse sequelae. Granulomatous tonsillitis as a reflection of systemic disease (e.g., tuberculosis or sarcoid) has been recorded only in instances of concurrent clinical illness. The incidence of tonsillar involvement in other potential granuloma-producing conditions (e.g., Crohn's disease, Yersinia pseudotuberculosis infection or fungus) is unknown. Direct cultures of tonsils typically yield multiple aerobic and anaerobic organisms; however, granuloma eliciting organisms have not been sought. These cases are clinically typical but pathologically unusual because of the tissue reaction identified. Given the extent of the usual clinical and pathologic evaluations of patients with chronic recurrent tonsillitis, the most reliable means of assessing the significance of the granulomas is by clinical follow-up: benign, in the cases reported here. Int J Surg Pathol 3(1):23-28, 1995