Burkitt lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma characterized by rapid growth, and Burkitt lymphoma originating in the tonsil is rare. Most of the cases have no obvious specific symptoms in the early stage, and the clinical symptoms are varied. Children’s symptoms are more atypical, which are easy to be misdiagnosed and missed. We report a case of adolescent with unilateral tonsil enlargement in our hospital, who was diagnosed with Burkitt lymphoma (BL). For patients with rapid enlargement of the tonsils in a short period, asymmetry of the tonsils (Brodskyscale tonsil size difference ≥ 2 degrees), mainly local symptoms but without obvious systemic symptoms, and rare enlarged lymph nodes in the neck, and no obvious abnormalities in laboratory tests, CT or MRI examination of the neck, or further PET/CT examination should be completed in time. When suspected malignant tumors revealed on imaging, especially high value of SUVmax on PET/CT, tonsil biopsy should be performed. Early detection. Early diagnosis can improve the prognosis of Burkitt lymphoma. In this case, the diagnosis was timely and accurate. Surgical resection of the left tonsil alleviated local symptoms in this cas, and chemotherapy treatment was timely completed after postoperative pathology. Efficacy of surgery combined with chemotherapy is good for the patient and long-term follow-up is available.