Descending necrotising mediastinitis: how a sore throat can result in purulent peritonitis

2021 ◽  
Vol 14 (5) ◽  
pp. e242145
Author(s):  
Darragh Rice ◽  
Naomi Fearon ◽  
John V Reynolds ◽  
Narayanasamy Ravi
Keyword(s):  
Rare Case ◽  
Antimicrobial Treatment ◽  
Clinical Suspicion ◽  
Management Options ◽  
Cervical Incision ◽  
Oropharyngeal Infection ◽  
Purulent Peritonitis ◽  
Remarkable Recovery ◽  
Life Threatening ◽  
Deteriorating Patient

This is a rare case of descending necrotising mediastinitis (DNM) that originated as an oropharyngeal infection, before spreading caudally to include all compartments of the mediastinum and the peritoneum beyond. The mediastinitis was treated early and aggressively with drainage, lavage and debridement in conjunction with broad-spectrum antimicrobial treatment. This case includes a right cervical incision, and a seldom needed surgical laparotomy approach to address the intra-abdominal involvement, and necessity of peritoneal washout. Following a prolonged Intesive Care Unit (ICU) stay and antibiotic course as well as other interventions detailed, the patient made a remarkable recovery and was discharged 101 days post presentation. This report goes on to discuss the rapidly evolving, life-threatening nature of DNM as well as providing an overview of possible management options, outlining how we think such cases should be approached and the clinical suspicion required in a deteriorating patient.

Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition

2021 ◽  
Vol 14 (7) ◽  
pp. e243412
Author(s):  
Chee Chean Lim ◽  
Jeyasakthy Saniasiaya ◽  
Jeyanthi Kulasegarah
Keyword(s):  
Infectious Disease ◽  
Rare Case ◽  
Clinical Suspicion ◽  
Near Miss ◽  
Emergency Setting ◽  
History Taking ◽  
Suppurative Otitis Media ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
History Of

Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.

scholarly journals Hair Dye poisoning – A rare case Report

2015 ◽  
Vol 3 (2) ◽  
pp. 72-73
Author(s):  
N.S. Neki ◽  
Ankur Jain ◽  
Rohit Bajaji ◽  
Mohit Manav Jindal
Keyword(s):  
Internal Medicine ◽  
Case Report ◽  
Rare Case ◽  
Multiorgan Failure ◽  
Supportive Therapy ◽  
Clinical Suspicion ◽  
Hair Dye ◽  
Rare Case Report ◽  
Life Threatening ◽  
Main Component

Hair dye poisoning is not uncommon but an emerging entity in India with increased morbidity and mortality. The main component of hair dye poisoning is paraphenylenediamine (PPD), which is highly toxic thus making it life threatening. PPD poisoning can result in various toxic effects, multiorgan failure and ultimately death. Clinical suspicion and timely management can improve the outcome. We report a case of 35 year old male presented to hospital within 4 hours of consuming hair dye with complaints of swelling of face and neck, vomiting and difficulty in breathing. He was satisfactorily managed with supportive therapy and endotracheal intubation and discharged without any ill effects.Journal of Advances in Internal Medicine 2014;3(2):72-73

scholarly journals Lemierre’s Syndrome: Rare, but Life Threatening—A Case Report withStreptococcus intermedius

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Shalini Gupta ◽  
Shehzad S. Merchant
Keyword(s):  
Early Recognition ◽  
Diagnostic Delay ◽  
Fusobacterium Necrophorum ◽  
Antimicrobial Treatment ◽  
Lemierre’S Syndrome ◽  
Presenting Symptoms ◽  
Oropharyngeal Infection ◽  
Life Threatening ◽  
Lemierre's Syndrome ◽  
Early Phases

Lemierre’s syndrome (LS) is a rare, but a life-threatening complication of an oropharyngeal infection. Combinations of fever, pharyngitis, dysphagia, odynophagia, or oropharyngeal swelling are common presenting symptoms. Infection of the lateral pharyngeal space may result in thrombosis of the internal jugular vein, subsequent metastatic complications (e.g., lung abscesses, septic arthritis), and significant morbidity and mortality. LS is usually caused by the gram-negative anaerobic bacillusFusobacterium necrophorum, hence also known as necrobacillosis. We present a case of LS caused byStreptococcus intermedius, likely secondary to gingival scraping, in which the presenting complaint was neck pain. The oropharyngeal examination was normal and an initial CT of the neck was done without contrast, which likely resulted in a diagnostic delay. This syndrome can be easily missed in early phases. However, given the potential severity of LS, early recognition and expedient appropriate antimicrobial treatment are critical.S. intermediusis an unusual cause of LS, with only 2 previous cases being reported in the literature. Therefore, an awareness of the myriad presentations of this syndrome, which in turn will lead to appropriate and timely diagnostic studies, will result in improved outcome for LS.

scholarly journals Asymptomatic Presacral Paraganglioma: Management of an Unpredictable Intraoperative Finding

2020 ◽  
Vol 06 (02) ◽  
pp. e131-e134
Author(s):  
Athina A. Samara ◽  
Alexandros Diamantis ◽  
Dimitrios Symeonidis ◽  
Athanasios Anagnostou ◽  
Andreas Marios Diamantis ◽  
...  
Keyword(s):  
Neural Crest ◽  
Neuroendocrine Tumors ◽  
Rare Case ◽  
Intraoperative Complications ◽  
Hypertensive Crisis ◽  
Clinical Suspicion ◽  
Anatomical Location ◽  
Presacral Mass ◽  
Life Threatening ◽  
High Level

AbstractParagangliomas are rare neuroendocrine tumors originating from the embryological neural crest. We report a rare case of a patient with an asymptomatic presacral mass (incidentaloma) who experienced an unpredictable intraoperative hypertensive crisis after manipulation of the tumor. Presacral neoplasms pose a diagnostic and therapeutic challenge due to their obscure anatomical location and the difficulty in performing an R0 excision. Furthermore, the management of asymptomatic paragangliomas requires a high level of clinical suspicion and expertise due to potential life-threatening intraoperative complications.

A Rare Case of Tuberculous Prostatitis

2016 ◽  
Vol 1 (2) ◽  
pp. 33
Author(s):  
Nurul Yaqeen Mohd Esa ◽  
Mohammad Hanafiah ◽  
Marymol Koshy ◽  
Hilmi Abdullah ◽  
Ahmad Izuanuddin Ismail ◽  
...  
Keyword(s):  
Rare Case ◽  
Correct Diagnosis ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Tuberculosis Infection ◽  
Advanced Age ◽  
Immunocompromised Patients ◽  
Prostatic Biopsy ◽  
High Clinical Suspicion

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

scholarly journals A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110377
Author(s):  
Yasuhito Nakamura ◽  
Kiyoshi Doi ◽  
Syojiro Yamaguchi ◽  
Etsuji Umeda ◽  
Osamu Sakai ◽  
...  
Keyword(s):  
Rare Case ◽  
Aortic Wall ◽  
Aortic Rupture ◽  
Ascending Aorta ◽  
Bleeding Site ◽  
Penetrating Aortic Ulcer ◽  
Postoperative Course ◽  
Life Threatening ◽  
Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

scholarly journals Report of a Rare Case of Trauma-Induced Thyroid Storm

2002 ◽  
Vol 81 (8) ◽  
pp. 570-574 ◽  
Author(s):  
Neil M. Vora ◽  
Fred Fedok ◽  
Brendan C. Stack
Keyword(s):  
Nervous System ◽  
Rare Case ◽  
Hepatic Dysfunction ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Definitive Treatment ◽  
Thyroid Storm ◽  
Vehicle Accident ◽  
Hyperthyroid State ◽  
Life Threatening

Thyroid storm is a potentially life-threatening endocrinologic emergency characterized by an exacerbation of a hyperthyroid state. Several inciting factors can instigate the conversion of thyrotoxicosis to thyroid storm; trauma is one such trigger, but it is rare. Patients with thyroid storm can manifest fever, nervous system disorders, gastrointestinal or hepatic dysfunction (e.g., nausea, vomiting, diarrhea, and/or jaundice), and arrhythmia and other cardiovascular abnormalities. Treatment of thyroid storm is multimodal and is best managed by the endocrinologist and medical intensivist. Initial medical and supportive therapies are directed at stabilizing the patient, correcting the hyperthyroid state, managing the systemic decompensation, and treating the underlying cause. Once this has been achieved, definitive treatment in the form of radioactive ablation or surgery should be undertaken. We describe a case of thyroid storm in a young man that was precipitated by a motor vehicle accident.

scholarly journals Cardiac Aspergilloma: A Rare Case of a Cardiac Mass Involving the Native Tricuspid Valve, Right Atrium, and Right Ventricle in an Immunocompromised Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Christina S. Chen-Milhone ◽  
Kalyan Chakravarthy Potu ◽  
Sudhir Mungee
Keyword(s):  
Tricuspid Valve ◽  
Right Atrium ◽  
Rare Case ◽  
Opportunistic Infections ◽  
Immunocompromised Patient ◽  
Clinical Suspicion ◽  
Ventricular Rate ◽  
Immunocompromised Patients ◽  
Transthoracic Echocardiogram ◽  
The Right

Aspergillus can cause devastating opportunistic infections in immunocompromised patients. Rarely does this fungus invade the heart, and when it does, survival is especially poor despite optimal medical and surgical treatment. We report a case of cardiac aspergilloma with involvement of the tricuspid valve and both the right atrium and ventricle found on a transthoracic echocardiogram in an immunocompromised patient after developing atrial fibrillation with rapid ventricular rate. The findings from this case suggest that early clinical suspicion is critical in early diagnosis and thus early treatment.

scholarly journals Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription

2017 ◽  
Vol 5 ◽  
pp. 2050313X1769599 ◽  
Author(s):  
Thomas J Reilly ◽  
Sean Cross ◽  
David M Taylor ◽  
Richard Haslam ◽  
Sophie C Tomlin ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Adverse Drug Reaction ◽  
Pulmonary Embolism ◽  
Neuroleptic Malignant Syndrome ◽  
Kidney Injury ◽  
Clinical Suspicion ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Intravenous Fluids ◽  
Life Threatening

Objectives: To describe a case of neuroleptic malignant syndrome following antipsychotic treatment of catatonia, highlighting the potentially serious complications of this rare adverse drug reaction. Methods: We present a case report of a patient who developed this syndrome with various sequelae. Results: The patient developed neuroleptic after being treated with lorazepam and olanzapine for catatonia. He subsequently developed the complications of rhabdomyolysis, acute kidney injury, pulmonary embolism, urinary retention and ileus. He received high-dose lorazepam, anticoagulation and intravenous fluids. Antipsychotic medication in the form of haloperidol was reinstated with no adverse effect, and he went on to make a full recovery. Conclusions: This case illustrates the potential life-threatening complications of neuroleptic malignant syndrome and the need for a low index of clinical suspicion. It also highlights the lack of evidence for treatment of catatonia, including the use of antipsychotics.

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