Spontaneus tonsillar hemorrhage.

Spontaneous tonsillar hemorrhage is a rare event; most of these cases have been the result of infectious tonsillitis.1 There are reported cases of spontaneous tonsillar hemorrhage in medical literature associated with bacterial infection, measles virus infection, infectious mononucleosis, peritonsillar, parapharyngeal and retropharyngeal abscesses and, less frequently, vascular malformation, aneurisms or pseudoaneurisms of the carotid and superficial temporal arteries, von Willebrand’s disease and local or regional cancer. In a review of literature, Lourenço et al. found 21 cases of spontaneous tonsillar hemorrhage resulting from acute tonsillitis. Cases of spontaneous hemorrhage have been reported in peritonsillar abscesses, mostly when spontaneous drainage occurred during the pre-antibiotic era. The prevalence of hemorrhage associated with infectious mononucleosis is 3 to 6.9%; of these, 2.2% presented oropharyngeal hemorrhage. Thrombocytopenia is associated with this condition, but hemorrhage may result only due to local inflammation, necrosis and erosion of superficial tonsillar blood vessels. In measles, hemorrhagic complications are uncommon. However, there is a rare variant known as hemorrhagic measles that affects mostly immunocompromised patients. Tonsillar hemorrhage is a rare finding in von Willebrand’s disease. There are 2 cases reported in literature where tonsillar hemorrhage was the first manifestation of this disease. An explanation of the pathophysiology of this type of hemorrhage is that acute inflammation results in increased blood flow to the tonsils, secondary edema, and vascular congestion; during the local inflammatory process, superficial dilated blood vessels undergo necrosis and bleed. In the pre-antibiotic era these hemorrhages were fatal; they were commonly due to erosion of major vessels, secondary do deep abscesses. Currently, most tonsillar hemorrhages are mild and result from the bleeding of superficial peripheral blood vessels. We report the following case to discuss the etiology and clinical strategies in spontaneous tonsillar hemorrhage.