Parapharyngeal abscess secondary to quinsy is a well understood complication; however, its incidence has significantly declined following early use of effective antibiotics. Tracking of infection from the parapharyngeal space through the anatomical planes to cause mediastinitis has a significant mortality rate and requires early detection and aggressive management. A case of quinsy leading to mediastinitis, pericarditis and pleural effusions is presented. It highlights the potentially life-threatening complications of a commonly encountered ENT problem.