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Swollen Tonsil With Black Spots On Tongue. Had Several Strep Throat & Treated With Antibiotics. What Could Be This?
Question: Hello,
I have had several cases of strep throat in the past several years, all treated with antibiotics. About 6 months ago I was treated for strep again, at that time my left tonsil was the only one that seemed to be affected/swollen w/pus spots. Since the last bout of strep, 6 months ago, the left tonsil still is swollen and in the last couple of days I have noticed black spots on my tongue back near the swollen left tonsil. I have an appointment with an ENT in 3 weeks (the soonest they can get me in). My question is: What are your thoughts regarding what this could possibly be? Should I request to see an ENT sooner than 3 weeks? Also, I have a great picture of the tonsil and black spots that I have attached. Thank you. XXXXXXX YYYY@YYYY or 000-000-0000
I have had several cases of strep throat in the past several years, all treated with antibiotics. About 6 months ago I was treated for strep again, at that time my left tonsil was the only one that seemed to be affected/swollen w/pus spots. Since the last bout of strep, 6 months ago, the left tonsil still is swollen and in the last couple of days I have noticed black spots on my tongue back near the swollen left tonsil. I have an appointment with an ENT in 3 weeks (the soonest they can get me in). My question is: What are your thoughts regarding what this could possibly be? Should I request to see an ENT sooner than 3 weeks? Also, I have a great picture of the tonsil and black spots that I have attached. Thank you. XXXXXXX YYYY@YYYY or 000-000-0000
Hi
Thanks for writing in.
I have seen the pictures and it seems to be a unilateral ( single sided) hypertrophy ( enlargement0 of the tonsil with follicles and petechial spots (bleeding spots).
It is not very unusual to have a unilateral enlargement of the tonsil, but at the same time we need to rule out a condition called Infectious Mononucleosis (glandular fever). The salient features of this condition are recurrent attacks of sore throat with unilateral enlargement of tonsil, pharyngeal inflammation, petechiae, fever, fatigue, malaise, vomiting, loss of appetite, enlarged lymph nodes (glands), etc.
Secondly, the black spots are usually seen in those individuals having repeated throat infection and smokers. These black spots are the pigmentation seen due to minute capillary bleeding and they are relatively harmless.
I would suggest you consult your doctor and get complete blood count and serological test called XXXXXXX Bunnel Test done to rule out infectious mononucleosis. Also, drink plenty of warm water, do gargles with povidone iodine solution; avoid smoking and chilled beverages.
I hope I have addressed your concerns; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Thanks for writing in.
I have seen the pictures and it seems to be a unilateral ( single sided) hypertrophy ( enlargement0 of the tonsil with follicles and petechial spots (bleeding spots).
It is not very unusual to have a unilateral enlargement of the tonsil, but at the same time we need to rule out a condition called Infectious Mononucleosis (glandular fever). The salient features of this condition are recurrent attacks of sore throat with unilateral enlargement of tonsil, pharyngeal inflammation, petechiae, fever, fatigue, malaise, vomiting, loss of appetite, enlarged lymph nodes (glands), etc.
Secondly, the black spots are usually seen in those individuals having repeated throat infection and smokers. These black spots are the pigmentation seen due to minute capillary bleeding and they are relatively harmless.
I would suggest you consult your doctor and get complete blood count and serological test called XXXXXXX Bunnel Test done to rule out infectious mononucleosis. Also, drink plenty of warm water, do gargles with povidone iodine solution; avoid smoking and chilled beverages.
I hope I have addressed your concerns; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by :
Dr. Aparna Kohli
On all occasions of the strep throat, strep was confirmed by lab test. Also, I do not drink alcohol and I have never smoked.
Do you still think it could be mono?
Would you recommend a tonsillectomy?
The last 6 months or so I just have not felt very good at all. My heart would race, so my doctor sent me for heart testing. It was revealed in those heart test that I have tachycardia. For the tachycardia (SVT), the doctor just has me on a 6 month follow-up.
Could acute/chronic mono cause tachycardia?
Dr XXXXXXX I just went to a outpatient clinic and they ran a quick mono test and retested me for strep, both came back negative. The doctor said their concern now is the fatigue, asymmetrical tonsil swelling, unilateral black discoloration on the tongue near the swollen tonsil, and me having difficulties swallowing. They just said that I needed to see the ENT.
Question:
1. What is your opinion on what it could be now that there is a negative mono and negative strep test?
Thank you again for your help.
XXXXXXX
Do you still think it could be mono?
Would you recommend a tonsillectomy?
The last 6 months or so I just have not felt very good at all. My heart would race, so my doctor sent me for heart testing. It was revealed in those heart test that I have tachycardia. For the tachycardia (SVT), the doctor just has me on a 6 month follow-up.
Could acute/chronic mono cause tachycardia?
Dr XXXXXXX I just went to a outpatient clinic and they ran a quick mono test and retested me for strep, both came back negative. The doctor said their concern now is the fatigue, asymmetrical tonsil swelling, unilateral black discoloration on the tongue near the swollen tonsil, and me having difficulties swallowing. They just said that I needed to see the ENT.
Question:
1. What is your opinion on what it could be now that there is a negative mono and negative strep test?
Thank you again for your help.
XXXXXXX
Hi
Thanks for writing back
It is good news that the Monospot test and the test for streptococcus has turned out to be negative. Then in that case, the dark lesions near the tonsillar tissue could be just a mere collection of blood in the capillaries following recurrent tonsillar infection.
1. What is your opinion on what it could be now that there is a negative mono and negative strep test?
The tonsil could be a major source of infection either for Streptococcus or EB virus (causative organism for Infectious Mononucleosis). In the absence of either of the causative organisms the swelling over the tonsil could be just an inflammation secondary to the chronic infective process. It would be better to get the tonsils excised and sent for biopsy to look for the actual pathology and any other super-added infection. It would also be beneficial in future, as the foci of recurrent infections will be removed.
The tachycardia and fatigue is usually noticed in acute phase of infection. Negative Monospot test has ruled out any correlation of tachycardia with Infectious Mononucleosis. The fatigue could be either antibiotic induced or presence of dormant infection. I do feel you should go ahead and get the surgery done at the earliest. Meanwhile, you can follow the suggestions I made in my previous post, till you consult your ENT specialist.
I wish you good health.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Thanks for writing back
It is good news that the Monospot test and the test for streptococcus has turned out to be negative. Then in that case, the dark lesions near the tonsillar tissue could be just a mere collection of blood in the capillaries following recurrent tonsillar infection.
1. What is your opinion on what it could be now that there is a negative mono and negative strep test?
The tonsil could be a major source of infection either for Streptococcus or EB virus (causative organism for Infectious Mononucleosis). In the absence of either of the causative organisms the swelling over the tonsil could be just an inflammation secondary to the chronic infective process. It would be better to get the tonsils excised and sent for biopsy to look for the actual pathology and any other super-added infection. It would also be beneficial in future, as the foci of recurrent infections will be removed.
The tachycardia and fatigue is usually noticed in acute phase of infection. Negative Monospot test has ruled out any correlation of tachycardia with Infectious Mononucleosis. The fatigue could be either antibiotic induced or presence of dormant infection. I do feel you should go ahead and get the surgery done at the earliest. Meanwhile, you can follow the suggestions I made in my previous post, till you consult your ENT specialist.
I wish you good health.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
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Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Dr. Naveen Kumar Nanjasetty
Otolaryngologist / ENT Specialist
Practicing since :2001
Answered : 2540 Questions
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