A 16-year-old girl of Puerto Rican descent presented with a 3-day history of a worsening “swollen throat.” During the preceding 8 weeks, she had a sensation of throat swelling, snoring, and restless sleep. She also reported a 5-month history of nonpurulent cough and hemoptysis. Additional review of systems was negative. Her family had a pet cat but denied any other animal exposure or recent travel. On physical examination, the patient appeared healthy, without evidence of dyspnea or stridor. She had an edematous soft palate, without erythema. Nasal endoscopy revealed edema of the hypopharynx and supraglottis. There was no erythema or other infectious stigmata in the oral cavity, oropharynx, or larynx. The rest of the head and neck examination, a complete blood cell count, and a chest x-ray film revealed no abnormalities. The erythrocyte sedimentation rate was elevated (34 mm/h [reference range, 0-17 mm/h]).
Hill CA, Maturo S, Gallagher TQ, Whelan P, Pasternack MS, Hartnick CJ, Kieff DA. Pathology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2012;138(3):317. doi:10.1001/archoto.2011.1238a