Peritonsillar abscess predominantly presents as a routine emergency review for otolaryngology and head and neck surgery registrars. Often straightforward, there can be many complicating factors such as malignancy which can present with mucosal ulceration. Our case report outlines the confusing presentation of 41-year-old patient KG, who presented with a five-day history of worsening trismus, right sided odynophagia along with a week-long history of soft palate mucosal changes. KG was a 20-pack year smoker and had a history of Behçet’s disease which had been in remission for many years without treatment. Examination revealed extensive soft palatal ulceration extending from the peritonsillar region to the retromolar trigone with overt fullness and uvula deviation. CT was performed at peripheral site which confirmed a 35x25mm associated abscess. Given the acute nature of the symptoms the decision was made to incise and drain with biopsies of the overlying mucosa to ascertain whether there was any malignancy. Biopsies reassuringly showed chronic inflammation without any evidence of dysplasia or malignancy. KG took a significantly long time to heal from the incision and drainage with a prolonged two-month recovery. The complexity of this presentation led to a rheumatology referral, where it was determined that the ulceration was a likely recurrence of Behçet’s disease overlying the site of a peritonsillar abscess. This case highlights the diagnostic challenge posed by atypical ulcerations in the oral cavity and the importance of considering both recurrent inflammatory conditions and malignancy in differential diagnoses. Initial review (highlighted in our photos) shows the perplexing and concerning nature of this presentation which could convince most clinicians of a neoplastic cause.