Q. I have enlarged tonsils with lump and fever. What could it be?

Answered by
Dr. Syed Tehmid
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 23, 2020

Hello doctor,

Three weeks ago, I noticed my left tonsil seems slightly enlarged and I have a lump with white head right behind it. A little background for the past six months, I have been experiencing daily low fevers and severe night sweats which are undiagnosed. My PCP told me it was just a tonsil stone but I am almost positive it is not. It looks nothing like any that I have seen in my research. I would love to submit a photo for a second opinion. I will eventually make it to an ENT if needed but with the coronavirus, I would like to wait if it is nothing to worry about.

Most labs (done prior to lump) looked normal except I had a positive ana with a low titer 1:40. My CRP was considered normal but 5.1 which says I am high risk for heart disease. I am a pretty active, healthy 34-year-old so while considered normal, it seems off to me. Chest x-ray looked normal. TB test negative.



Welcome to

You are right it is not a tonsillolith, it is a tonsillar cyst. Indeed, it is nothing to worry about and such a small may not even need any treatment. Furthermore, your tonsils are not that grossly enlarged or even congested to give you the spikes of fever. Low-grade fevers and night sweats need to be evaluated for other more important causes like tuberculosis. Have you done any serological tests and baseline blood tests?

Thank you doctor,

I have lots of bloodwork. All are normal expect ANA was positive 1:40 titer and CPR was considered normal but high risk for heart disease at 5.1 and I am a pretty active, healthy 34-year-old. TB was negative. I do not think I have had any serological tests. I have a rheumatologist appointment in a month or so. Whether my prior symptoms and the swollen throat and cyst could be related to lymphoma?



Welcome back to

Well, your doctor must be suspecting a connective tissue disorder or a systemic vasculitis syndrome. This is an important cause of fever of unknown origin with generalized body aches. Your rheumatologist will guide you in a better way in this regard. What can assure you is that your tonsils do not appear to me be any grossly enlarged to suspect lymphoma. Tonsillar cysts are fairly common and you do not need to worry. Your tonsillar morphology is normal and they are not grossly enlarged.

Further, it is wise to go for serological tests like HIV (human immunodeficiency virus), Anti HBS Ag (hepatitis B surface antigen) and Anti HCV (hepatitis C virus). Even they can present with fever of unknown origin.

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