Acute adult pharyngitis is a common reason to visit the primary care physician's office. Without knowledge of the natural course of acute pharyngitis in the adult patient, it can be easy to miss a serious complication. We offer the case of a 46 year-old man who initially presented with acute pharyngitis and eventually developed a peritonsillar abscess requiring intubation and intensive care unit admission. We hope to further clarify the normal natural history of adult pharyngitis and suggest clinical guidelines in the event of worsening pharyngitis.