Lemierre syndrome – a forgotten complication of acute tonsillitis

1995 ◽  
Vol 109 (7) ◽  
pp. 657-661 ◽  
Author(s):  
C. B. Koay ◽  
T. Heyworth ◽  
P. Burden
Keyword(s):  
Young Adults ◽  
Mortality Rate ◽  
Clinical Picture ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Disease Process ◽  
Acute Tonsillitis ◽  
Lemierre Syndrome ◽  
Threatening Condition ◽  
Life Threatening

AbstractLemierre syndrome, also known as postanginal sepsis, is an illness characterized by the development of a fusobacterial septicaemia with multiple metastatic foci following an attack of acute tonsillitis. It typically affects previously healthy adolescents and young adults who, following an attack of sore throat, become acutely ill with hyperpyrexia, rigors and multiple metastatic abscesses. The clinical picture tends to vary widely because of the possible involvement of a number of body systems and organs in the disease process. This serious complication of oropharyngeal sepsis had a mortality rate in excess of 90 percent in the pre-antibiotic era. Although now rarely seen and often forgotten, it remains a potentially life-threatening condition. We present four cases of post-tonsillitis fusobacterial septicaemia to illustrate the variability of the clinical presentation and stormy clinical course frequently associated with this rare syndrome.

scholarly journals Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Santiago Fabián Moscoso Martínez ◽  
Evelyn Carolina Polanco Jácome ◽  
Elizabeth Guevara ◽  
Vijay Mattoo
Keyword(s):  
Myelodysplastic Syndrome ◽  
Clinical Presentation ◽  
Renal Involvement ◽  
Medical Emergency ◽  
Complete Blood Cell Count ◽  
Blood Cell Count ◽  
Thrombocytopenic Purpura ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

Epidemiology and clinics of mushroom poisoning in Northern Italy: A 21-year retrospective analysis

2017 ◽  
Vol 37 (7) ◽  
pp. 697-703 ◽  
Author(s):  
G Cervellin ◽  
I Comelli ◽  
G Rastelli ◽  
F Sanchis-Gomar ◽  
F Negri ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Early Identification ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Clinical Information ◽  
Northern Italy ◽  
Gastrointestinal Toxicity ◽  
Mushroom Poisoning ◽  
Limited Information ◽  
Life Threatening

Background: Limited information exists about epidemiology and management of mushroom poisoning. We analyzed and described epidemiology, clinical presentation, and clinical course of mushroom-poisoned patients admitted to emergency departments (EDs) of the Province of Parma, Italy. Methods: Data from the database of mycological service were matched with clinical information retrieved from hospitals’ database, from January 1, 1996 to December 31, 2016. Results: Mycologist consultation was obtained in 379/443 identified mushroom poisonings. A remarkable seasonality was found, with significant peak in autumn. Thanks to the collaboration, the implicated species could be identified in 397 cases (89.6%); 108 cases (24.4%) were due to edible mushrooms, Boletus edulis being the most represented (63 cases). Overall, 408 (92%) cases presented with gastrointestinal toxicity. Twenty cases of amatoxin poisoning were recorded (11 Amanita phalloides and 9 Lepiota brunneoincarnata). One liver transplantation was needed. We observed 13 cases of cholinergic toxicity and 2 cases of hallucinogenic toxicity. Finally, 46 cases were due to “mixed” toxicities, and a total of 69 needed hospitalization. Conclusions: Early identification and management of potentially life-threatening cases is challenging in the ED, so that a mycologist service on call is highly advisable, especially during periods characterized by the highest incidence of poisoning.

PS02.056: TIMELY LIGATION OF THORACIC DUCT IN POST ESOPHAGECTOMY CHYLE LEAK: KEY TO SUCCESSFUL MANAGEMENT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 136-136
Author(s):  
Sanjeev Parshad ◽  
Parvinder Sandu ◽  
Shekar Gogna ◽  
Abhijeet Beniwal ◽  
Rajendra Karwasra
Keyword(s):  
Mortality Rate ◽  
Thoracic Duct ◽  
Conflicts Of Interest ◽  
Surrounding Tissue ◽  
Chyle Leak ◽  
Threatening Condition ◽  
Life Threatening ◽  
Carcinoma Esophagus ◽  
Esophagectomy For Cancer

Abstract Background Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus. Methods From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct. Results Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct. Conclusion Disclosure All authors have declared no conflicts of interest.

Deep venous thrombosis in the clinical course of pulmonary embolism

2018 ◽  
Vol 34 (7) ◽  
pp. 453-458
Author(s):  
Natalia Stoeva ◽  
Milena Staneva ◽  
Galina Kirova ◽  
Rumiana Bakalova
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Pulmonary Artery ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Clinical Signs ◽  
Arterial Blood ◽  
Severe Clinical Presentation

Objectives The aim of the study is to find how concomitant deep venous thrombosis (DVT) changes the clinical course of pulmonary embolism. Methods Three hundred and five patients with pulmonary embolism were examined and grouped into DVT and non-DVT groups. Both groups were compared with regard to demography, predisposing factors, clinical signs, thrombotic burden, and one-month mortality rate. Results The patients with DVT had a more severe clinical presentation: higher heart rate (94.80 ± 18.66 beats per minute versus 87.9 ± 13.90 in the non-DVT group, p = 0.00033), more hemodynamic instability (11.35% versus 3.05% in the non-DVT group, p = 0.005), and less pCO2 in arterial blood gases (30.81 ± 7.94 mmHg versus 32.59 ± 7.35 mmHg in the non-DVT group, p = 0.049). The DVT group had heavier thrombotic burden in pulmonary artery, measured by Mastora score. The one-month mortality rate did not differ statistically between groups. Conclusions Patients with symptomatic pulmonary embolism and concomitant DVT have heavier thrombotic burden in the pulmonary artery and more severe clinical presentation compared to those without DVT, but a similar one-month mortality rate.

Pleomorphic xanthoastrocytoma presenting with life-threatening hemorrhage in a child

2009 ◽  
Vol 3 (2) ◽  
pp. 157-159 ◽  
Author(s):  
Joshua J. Wind ◽  
P. Benjamin Kerr ◽  
Jennifer A. Sweet ◽  
Vivek R. Deshmukh
Keyword(s):  
Intracerebral Hemorrhage ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Case Reports ◽  
Young Patients ◽  
Pleomorphic Xanthoastrocytoma ◽  
First Case ◽  
Life Threatening

Pleomorphic xanthoastrocytomas are glial-based tumors that arise most frequently in young patients and usually follow a more benign and indolent clinical course than their other glial-based tumor counterparts. These tumors most frequently present with seizures, and only 3 previous case reports exist of hemorrhagic tumor as the clinical presentation. The authors present the first case of life-threatening intracerebral hemorrhage from pleomorphic xanthoastrocytoma in a child.

scholarly journals Acute ileocolitis as a presentation of Sars Cov-2 infection in children- A case report

2021 ◽  
Vol 7 (4) ◽  
pp. 218-220
Author(s):  
Raghavendra H Gobbur ◽  
Ranjima M Mahesh
Keyword(s):  
Clinical Presentation ◽  
Acute Liver Injury ◽  
Kidney Injury ◽  
Symptomatic Infection ◽  
Pain Abdomen ◽  
Asymptomatic Children ◽  
Threatening Condition ◽  
Life Threatening ◽  
Inflammatory Syndrome ◽  
The Impact

As COVID-19 continues to spread in India and other countries, the impact of the disease among children, initially considered less important, is becoming more relevant. The extent of the diversity of clinical presentation of COVID-19 in children are still unclear. We have already seen a new clinical picture of SARS-CoV-2 in children manifesting as a hyper-inflammatory syndrome, with multi-organ involvement similar to Kawasaki Disease and with potential evolution to a shock syndrome. This represented a new phenomenon affecting previously asymptomatic children with SARS-CoV-2 infection. COVID-19 may also manifest as viral hepatitis, acute pancreatitis, acute liver injury, acute kidney injury, ARDS, Sepsis, septic shock and meningo-encephalitis and cerebellar ataxia. The Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection occurs weeks after infection and may evolve unnoticed. MIS-Cs pathophysiology remains unclear. However, it appears to be a postinfectious hyperimmune response that may occur during or following asymptomatic or symptomatic infection. COVID-19 infection in children may lead to a potentially life threatening condition that we may not be aware of. We are in need of reporting of the diverse presentation of SARS CoV-2 virus in children. Here we describe a case of a previously normal 14-year-old boy who manifested with severe pain abdomen after SARS CoV-2 infection and was diagnosed as Acute Ileocolitis secondary to COVID-19. Child improved with steroid therapy and was asymptomatic after 3 weeks of treatment.

scholarly journals Gastric Pneumatosis: Emphysematous Gastritis versus Gastric Emphysema

2019 ◽  
Vol 02 (02) ◽  
pp. 151-154
Author(s):  
Amit Kumar Paliwal ◽  
Sachin Girdhar ◽  
Somali Pattanayak ◽  
Brajesh Kumar
Keyword(s):  
Abdominal Surgery ◽  
Diabetic Patient ◽  
Clinical Presentation ◽  
Favorable Outcome ◽  
Radiological Findings ◽  
Benign Condition ◽  
Emphysematous Gastritis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Gastric Emphysema

AbstractPresence of air in the wall of the stomach is known as gastric pneumatosis. It may be associated with a benign condition like gastric emphysema (GE) to life threatening condition emphysematous gastritis (EG). Differentiation between two entities based on clinical presentation, predisposing factors, and radiological findings is important as EG has more complications and higher rates of mortality. The treatment in GE is conservative while treatment in EG is evolving. We present a case of a diabetic patient who developed EG following abdominal surgery and managed conservatively with favorable outcome.

Abacavir Hypersensitivity Reaction: The First Case Report in Thailand and Literature Review

2021 ◽  
Vol 104 (1) ◽  
pp. 159-163
Keyword(s):  
Developing Countries ◽  
Case Report ◽  
Hypersensitivity Reaction ◽  
Screening Test ◽  
Blood Test ◽  
Clinical Presentation ◽  
Health Security ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening

Abacavir-related hypersensitivity reaction (ABC-HSR) is a life-threatening condition. The incidence is low since it could have been prevented by screening with blood test for HLA-B*5701, which is strongly associated with this reaction. However, the affordability for the HLA-B*5701 screening test is still a challenging issue in many developing countries. Thai National Health Security Office (NHSO) recommends either using HLA-B*5701 as a screening test or monitoring clinical presentation for ABC-HSR after using it. Therefore, the clinical presentation of ABC-HSR should be acknowledged for the diagnosis of this condition and death prevention. This was the first reported case and literature reviewed of ABC-HSR associated with the presence of the HLA-B*5701 allele in Thailand. Keywords: Abacavir, Hypersensitivity reaction, HLA-B*5701, Clinical presentation, Thailand

Catastrophic antiphospholipid syndrome (Ronald Asherson syndrome) and obstetric pathology

2018 ◽  
Vol 46 (4) ◽  
pp. 387-400 ◽  
Author(s):  
Alexander D. Makatsariya ◽  
Jamilya Khizroeva ◽  
Viktoriya O. Bitsadze
Keyword(s):  
Mortality Rate ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Multiorgan Failure ◽  
Multiple Organ ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Small Vessels ◽  
Threatening Condition ◽  
Life Threatening ◽  
Large Vessels

Abstract Background: Catastrophic antiphospholipid syndrome (CAPS) is an uncommon, often fatal, variant of the antiphospholipid syndrome (APS) that results in a widespread coagulopathy and high titres of antiphospholipid antibodies (aPL) and affects predominantly small vessels supplying organs with the development of multiorgan failure. It remains unclear why some patients develop the typical clinical picture of APS (thrombosis of large vessels), whereas others show the development of progressive microthrombosis, which the authors called “thrombotic storm” and multiple organ failure, that is, CAPS. Materials and methods: Since 2001–2016, we discovered 17 patients with CAPS development. Conclusion: CAPS is life-threatening condition, but optimal treatment for CAPS is not developed yet and the mortality rate is as high as 30%–40%.

Severe case of Lemierre syndrome with multiple neurological and ophthalmological sequelae

2021 ◽  
Vol 14 (8) ◽  
pp. e244669
Author(s):  
Alice Liu ◽  
Jemma Taylor ◽  
Monica Slavin ◽  
Steven Tong
Keyword(s):  
Early Recognition ◽  
Surgical Excision ◽  
Severe Case ◽  
Intracranial Extension ◽  
High Dose ◽  
Lemierre Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Right ◽  
Discharge From Hospital

A 56-year-old man was admitted to intensive care with septic shock, multiple facial abscesses and thrombophlebitis of the right internal jugular vein with extensive intracranial extension. A diagnosis of Lemierre syndrome due to Streptococcus anginosus was made and treatment initiated with high-dose ceftriaxone and metronidazole, along with surgical debridement. His admission was complicated by raised intraocular pressures and visual loss requiring bilateral canthotomies. Despite therapeutic anticoagulation with enoxaparin, he also developed an ischaemic basal ganglia infarct. After a prolonged and complex hospital stay, the patient was later readmitted with an intracerebral abscess requiring surgical excision and a second course of antibiotics. This case highlights the value of early recognition of this rare but potentially life-threatening condition, considerations around anticoagulation and antibiotic decisions, and the importance of close multidisciplinary follow-up even after discharge from hospital.

Sign in / Sign up

Export Citation Format

Share Document