Neftaly Acute Viral Pharyngitis with Airway Obstruction

• Acute viral pharyngitis is an inflammation of the pharyngeal mucosa caused by viral infections.
• In rare instances, significant edema, tonsillar hypertrophy, or secondary bacterial superinfection can lead to upper airway obstruction.

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???? Common Viral Causes

• Adenovirus
• Influenza
• Parainfluenza
• Rhinovirus
• Enterovirus (e.g., Coxsackievirus)
• Epstein-Barr virus (EBV – mononucleosis)

EBV and adenovirus are more likely to cause severe tonsillar enlargement, especially in children or adolescents.

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???? Clinical Features

???? Typical Viral Pharyngitis:

• Sore throat
• Low-grade fever
• Nasal congestion, cough
• Mild erythema of throat, possible exudates
• Fatigue, malaise

???? Airway Obstruction Signs:

• Stridor
• Muffled voice (“hot potato voice”)
• Trismus (difficulty opening the mouth)
• Drooling
• Difficulty breathing or swallowing
• Neck swelling (especially submandibular or tonsillar)

❗Often confused with peritonsillar abscess or epiglottitis — careful evaluation is crucial.

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???? Diagnosis

• Clinical evaluation is key
• Consider:
  • Lateral neck X-ray: To rule out epiglottitis
  • Flexible nasopharyngolaryngoscopy: If airway involvement suspected
  • Monospot or EBV serology: In adolescents with massive tonsils
  • Throat swab: For viral PCR or rapid strep test (to rule out bacterial pharyngitis)

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????️ Management

???? 1. Airway Assessment First

• Evaluate for airway compromise
• If stridor, drooling, or hypoxia: prepare for intubation
• Early ENT/anesthesia involvement recommended

❗In massive tonsillar enlargement (

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