Lemierre's syndrome after evacuation of the uterus: a case report

Even minor surgical interventions can have serious complications. Lemierre's syndrome is rare and to our best knowledge never before described after gynecological surgery; however, it should be considered in case of rapidly developing respiratory problems after even simple surgical procedures.     

Lemierre's syndrome: Diagnosis in the emergency department

A 15‐year‐old boy presented with signs of sepsis and a history of sore throat, fevers and shortness of breath. Full examination revealed an erythematous oropharynx and mild tonsillar swelling. He rapidly deteriorated requiring admission to intensive care. Blood cultures grew Fusobacterium necrophorum and an ultrasound scan performed for left neck tenderness confirmed internal jugular vein thrombosis. He was diagnosed with Lemierre's syndrome. This condition results from pharyngitis or tonsillitis with bacterial spread to the lateral pharyngeal space. Internal jugular vein thrombosis ensues with septic emboli and metastatic infections that most frequently involve the lungs. Although increasing in incidence, diagnosis is often delayed. We discuss why and describe its clinical presentation, investigations of choice and treatment strategies.     

Osteomyelitis infection disguised as Reiter's syndrome in a child: A case report

Reiter''s syndrome (reactive arthritis) should always prompt a thorough clinical investigation of a potentially more serious disease condition in every pediatric patient and adults. It should always be regarded as a warning sign and not a disease. This is a case of a 16‐year‐old African boy with osteomyelitis presenting with symptoms of reactive arthritis (Reiter''s syndrome).     

Fever of unknown origin as the first presentation of candida vertebral osteomyelitis: A case report

Candida osteomyelitis is a rare disorder; however, its incidence has drastically risen especially during the last 3 decades. Diagnosis is usually delayed due to nonspecific symptoms. Thus, its management would not be performed at the proper time, which leads to increased morbidity. The optimal management of candida osteomyelitis is not clearly defined but most recommendations advise prolonged antifungal therapy in addition to surgery. Here, we report candida osteomyelitis in a patient with a history of pancreatic adenocarcinoma that presented with prolonged FUO as her first presentation. Fortunately, her symptoms completely resolved after prolonged medical therapy despite delay diagnosis due to her unusual presentation. To the best of our knowledge, it is the first report of candida vertebra osteomyelitis that presents with prolonged FUO as the first presentation.     

宏基因组学二代测序技术协助诊断Lemierre综合征1例报告

Lemierre综 合 征(Lemierre syndrome,LS)是一种不常见但具有致死性的厌氧菌性脓毒症.其典型特征为近期口咽部感染史,具有颈内静脉血栓形成的临床或影像学证据,查血能检出厌氧性病原体,特别是坏死梭杆菌[1-2].除原发口咽部感染灶外,LS常累及肺部,患者可出现肺部阴影[2].以往对于LS的病原学鉴...     

A case of acute exacerbation of chronic hepatitis C during the course of adrenal Cushing's syndrome

A 50‐year‐old woman with adrenal Cushing''s syndrome and chronic hepatitis C developed an acute exacerbation of chronic hepatitis C before adrenectomy. After administration of glecaprevir/pibrentasvir was started, her transaminase levels normalized promptly and a rapid virological response also was achieved. Laparoscopic left adrenectomy was then performed safely.     

A rare case of pulmonary nocardiosis comorbid with Sjogren’s syndrome

BackgroundNocardia is an opportunistic pathogen, which occurs in patients with autoimmune diseases and immune dysfunction, and can cause bacteremia and other life‐threatening complications. The clinical manifestations of Nocardia pneumonia are similar to tuberculous and other clinical common bacterial pneumonia, but its antibacterial treatments are different and detection methods are unique, which may lead patients to suffer for many years due to clinical misdiagnosis and missed diagnosis.MethodsImaging and laboratory examinations were performed for preliminary diagnosis, and next‐generation sequencing was used to identify the exact species type of Nocardia in the bronchoalveolar lavage fluid (BALF) of the patient.ResultsImaging and laboratory parameters preliminarily implied that the patient was infected with Nocardia with Sjogren''s syndrome (SS), and NGS showed that the strain was N. terpenica.ConclusionsAccurate etiological diagnosis and corresponding antibiotics are key to improve the prognosis of pulmonary nocardiosis in this case. Nocardia pneumonia is rare in clinical practice; it is of great medical significance to improve the understanding of pulmonary nocardiosis.     

Lemierre's syndrome complicating bacterial pharyngitis in a patient with undiagnosed factor XII deficiency

Internal jugular vein thrombosis occurs as an uncommon complication of oropharyngitis. The following case report describes a previously healthy adult woman who presented with sore throat, left ear pain, and fever. She was initially diagnosed with pharyngitis and inadvertently had blood cultures sent as part of her workup. She was then called back to the Emergency Department the following day for positive growth of the blood culture, and found to have thrombophlebitis of the internal jugular vein on computed tomography scan of the neck. Further workup revealed factor XII deficiency. The clinical course was further complicated by septic pulmonary emboli and disseminated intravascular coagulation. The patient was treated with broad-spectrum antibiotics and anticoagulation and made a full recovery.     

Polygraphic recordings in a case of Reye's syndrome

In a comatose patient with Reye's syndrome, stimulation that increased the heart rate also produced changes in the intracranial pulsations and pressure, as well as in the electroencephalogram.     

A rare initial presentation of a thymic neuroendocrine tumor as Cushing's syndrome

While evaluating the cause of Cushing''s syndrome, biochemical confirmation should be sought first as imaging studies might misdirect the diagnosis toward the wrong problem. One of the rare secondary causes that should be kept in mind while evaluating Cushing''s syndrome is the thymic neuroendocrine tumor.     

Munchausen's syndrome presenting as severe panniculitis

Factitious disorders may trouble any physician during his/her career. A considerable number of cases of Munchausen's syndrome (self-induced disorder) are misdiagnosed in clinical practice. A 36-year-old woman was admitted to our hospital because of fever and abdominal pain. Physical examination showed signs of inflammation of the abdominal wall, and histological examination revealed severe panniculitis. We investigated various aetiologic factors that could probably be related to fat necrosis, but we found no explanation of the phenomenon until we verified the diagnosis of Munchausen's syndrome. 2 years later, the patient underwent surgery for removal of needles, which she herself had deliberately located under her skin. High index of suspicion and physician's persistence are necessary to make the correct diagnosis in the various protean manifestations of Munchausen's syndrome.     

Sheehan's syndrome associated with pancytopenia due to marrow aplasia; full recovery with hormone replacement therapy

We describe a 52-year-old woman with pancytopenia associated with Sheehan's syndrome, whose presenting feature was severe malaise and syncope after a psychological stress. Hormonal replacement therapy alone (with L-thyroxine and prednisolone) produced clinical and full haematological recovery. This is a very rare case of Sheehan's syndrome because the diagnosis was delayed for 27 years after delivery, and it was associated with pancytopenia.