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.

scholarly journals Fulminant myocarditis: use of echocardiography from diagnosis to extracorporeal membrane oxygenation

2020 ◽  
Vol 7 (3) ◽  
pp. K21-K26
Author(s):  
Na Hyun Park ◽  
Hazem Lashin ◽  
Rosalba Spiritoso
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Early Recognition ◽  
Heart Function ◽  
Thrombus Formation ◽  
Fulminant Myocarditis ◽  
High Dose ◽  
List Type ◽  
Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening

Summary Fulminant myocarditis can present with life-threatening arrhythmias and cardiogenic shock due to ventricular failure. The diagnosis of myocarditis usually requires histological and immunological information, as its aetiology may be infectious (viral or non-viral), autoimmune or drug related. The treatment of fulminant myocarditis depends on the underlying cause but usually includes high dose systemic steroids as well as physiological support. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support patients as a bridge to recovery by supporting biventricular function and decompressing the heart. V-A ECMO carries risks and complications of its own such as thrombus formation or bleeding. Different diagnostic modalities, such as transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE), are central to the monitoring of progression of disease and recovery of heart function. This case highlights the importance of early recognition and early support with V-A ECMO in fulminant myocarditis, as well as the role of repeated echocardiography when weaning from physiological support. Learning points: Myocarditis is a life-threatening condition and early recognition of cardiac failure can be assisted with a bedside echocardiogram. Extracorporeal membrane oxygenation is used as a bridging method of treatment for patients with cardiogenic failure in myocarditis but has its own risks related to anticoagulation and the procedure itself. There are currently no standardised guidelines of when to wean a patient off extracorporeal membrane oxygenation, but echocardiography acts as an important guide to detect complications as well as cardiac recovery.

scholarly journals Respiratory Distress Syndrome Associated with Erythrodermic Psoriasis

2021 ◽  
pp. 83-88
Author(s):  
Lamya Noure ◽  
Kirley Küçük ◽  
Sylvain Raoul Simeni Njonnou ◽  
Véronique Del Marmol ◽  
Jonathan M. White ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Early Recognition ◽  
Past History ◽  
High Dose ◽  
Threatening Condition ◽  
Erythrodermic Psoriasis ◽  
Life Threatening ◽  
Dose Corticosteroid

Erythrodermic psoriasis is an uncommon and severe variant of psoriasis which may be associated with rare and severe complications such as acute respiratory distress syndrome. Early recognition of this life-threatening condition can allow prompt appropriate treatment. We report the case of a 69-year-old man with a long history of psoriasis who developed acute respiratory distress during a disease flare-up. There was no relevant past history (except for mild emphysema), known allergy, or recent treatment. Chest X-ray revealed new bilateral infiltrates, confirmed at chest computed tomography scan. Repeated cultures on aspirate of the bronchoalveolar lavage remained negative for viruses, bacteria, and parasites. Cardiac ultrasound was normal and high-dose corticosteroid therapy was initiated. Within a few days his clinical and radiological status improved significantly.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

scholarly journals Frontal sinus mucopyelocele with intracranial and intraorbital extension

1970 ◽  
Vol 3 (1) ◽  
pp. 91-92 ◽  
Author(s):  
S Gupta ◽  
R Goyal ◽  
M Shahi
Keyword(s):  
Ct Scan ◽  
Paranasal Sinuses ◽  
Frontal Sinus ◽  
Visual Loss ◽  
Early Recognition ◽  
Surgical Excision ◽  
Intracranial Extension ◽  
External Approach ◽  
Intracranial Complications ◽  
Symptoms And Signs

This case is related to a 52-year-old lady with proptosis, diplopia and diminution of vision due to a mass lesion in upper medial quadrant of the orbit. CT scan revealed a well defined mass in basi-frontal area with intra-orbital and intracranial extension. On exploring it was found to be mucopyocele of the frontal sinus. Surgical excision was done by external approach. The symptoms and signs resolved completely within a week. Frontal sinus mucopyoceles are benign and curable. Early recognition and management of them is of paramount importance because they can expand and cause local, orbital or intracranial complications. Keywords: Mucocele; mucopyocele; paranasal sinuses; visual loss; proptosis  DOI: 10.3126/nepjoph.v3i1.4287Nepal J Ophthalmol 2011;3(5):91-92

scholarly journals Necrotizing fasciitis with group A Streptococci and Eggerthella lenta as a complication of Varicella in a child – case presentation –

2014 ◽  
Vol 20 (1) ◽  
pp. 35-39
Author(s):  
Cambrea Simona Claudia ◽  
Ilie Maria Margareta ◽  
Carp Dalia Sorina ◽  
Ionescu C.
Keyword(s):  
Necrotizing Fasciitis ◽  
Severe Disease ◽  
The Body ◽  
Group A Streptococci ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
The Right ◽  
Surgery Department ◽  
Short Time

ABSTRACT Necrotizing fasciitis is a life threatening condition that can be quickly spread through the flesh surrounding the muscle. The disease can be polymicrobial, or caused by group A beta hemolytic Streptococci, or by Clostridium spp. We present a case of a 7 years old girl, which was hospitalized in Children Infectious Diseases Department in a 7th day of chickenpox (hematic crusts all over the body), high fever, asthenia, vomiting, oligoanuria, and tumefaction, pain and functio lessa in the right thigh. In a very short time in the right thigh swelling, edema and congestion have increased gradually, and in the third highest middle thigh the ecchymotic areas appeared evolving towards bubbles and blisters which included the right thigh and calf. After excluding the diagnosis of thrombophlebitis was raised suspicion of necrotizing fasciitis. CT pelvic scan evidenced pelvic asymmetry by maximus and medium right gluteal muscles swelling with important inflammatory infiltrate extended laterally in the subcutaneous adipose tissue. In blood culture was isolated Eggerthella lenta, and from throat swab was isolated group A Streptococci. Treatment consists of a combination of antibiotics associated with intravenous immunoglobulin administration. Despite medical treatment evolution worsened and required transfer in a pediatric surgery department where emergent surgical debridement associated with intensive antibiotic therapy was done. After this intervention evolution was slowly favorable without major limb dysfunction. Polymicrobial necrotizing fasciitis is a severe disease, which if recognized early can have a favorable outcome.

scholarly journals Stridor in infant caused by subglottic hemangiome: case report

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Raquel Lot ◽  
Caroline Rosa ◽  
Camila Freitas ◽  
Gracinda Adnet ◽  
Luisa Costa ◽  
...  
Keyword(s):  
Beta Agonist ◽  
First Year ◽  
Vascular Neoplasms ◽  
Threatening Condition ◽  
Life Threatening ◽  
Diagnostic Hypothesis ◽  
Therapeutic Measures ◽  
The Right ◽  
First Year Of Life ◽  
Age Range

Subglottic hemagioma is a rare cause of stridor, but it is one of the most common vascular neoplasms of the airways in childhood. If the treatment is not promptly instituted, it becomes a life-threatening condition. The diagnosis should be suspected when infants outside the age range for acute laryngitis present with stridor associated with severe respiratory effort, without viral prodromes, with a condition that is not responsive to initial therapeutic measures considering the main diagnostic hypothesis. Infantile hemangiomas begin to proliferate during the first year of life (between the 1st and 2nd month of life). Involution usually occurs between 6 months and 12 months of life (most involution until 4 years). The case is a 5-month-old female infant, with sudden stridor associated with respiratory distress without viral prodromes or fever, with little response to inhaled short-acting beta-agonist, inhaled adrenaline, as well as corticosteroids inhalation/parenteral. Bronchoscopy showed a bulging of the submucosa to the right of the subglottis with slight vascularization, suggestive of subglottic hemangioma. Treatment with propranolol was initiated orally with the aim of regressing the hemangioma and after clinical stability, the infant was discharged with outpatient follow-up.

Alcohol Related Non-traumatic Rhabdomyolysis and Compartment Syndrome

2007 ◽  
Vol 6 (1) ◽  
pp. 33-34
Author(s):  
JPL Ong ◽  
◽  
LA Thomas ◽  
Keyword(s):  
Skeletal Muscle ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Lower Extremity ◽  
Compartment Syndrome ◽  
Early Recognition ◽  
Clinical Entity ◽  
Threatening Condition ◽  
Life Threatening ◽  
Renal Support

Rhabdomyolysis is a serious and life-threatening condition in which skeletal muscle is damaged, commonly resulting in acute renal failure. The causes of this clinical entity can be traumatic and non-traumatic. In the latter group, alcohol is the commonest cause. This report describes the case of a 25 year old man who presented with rhabdomyolysis leading to acute renal failure after an alcohol binge. He presented with painful legs and lower extremity compartment syndrome. The patient recovered with surgical fasciotomy and renal support. This case illustrates the importance of early recognition and treatment of alcohol related non-traumatic rhabdomyolysis and compartment syndrome.

Assessment and care of the patient with sepsis

2020 ◽  
pp. 225-257
Author(s):  
Kevin Barrett
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Scoring Systems ◽  
Cardiovascular Responses ◽  
Physiological Changes ◽  
Assessment Framework ◽  
Threatening Condition ◽  
Life Threatening ◽  
Support Mechanisms ◽  
Sepsis And Septic Shock

There has been considerable recent focus on sepsis in both the clinical arena and within the general public to raise awareness of the importance of early recognition of this potentially life-threatening condition. The early recognition of sepsis by ward nurses can both reduce progression of this lethal disease and improve survival for patients in hospital. This chapter focuses on definitions of sepsis and septic shock, physiological changes associated with inflammatory and cardiovascular responses to sepsis, and a clinical assessment framework to guide practice. There is also a discussion of the use of scoring systems and how to escalate support mechanisms for patients with sepsis and septic shock.

Intracranial aneurysm following radiation therapy for medulloblastoma

1997 ◽  
Vol 38 (1) ◽  
pp. 37-42 ◽  
Author(s):  
F. K. Jensen ◽  
A. Wagner
Keyword(s):  
Radiation Therapy ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Distal Part ◽  
Anterior Cerebral Artery ◽  
Craniospinal Radiation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Radiation Induced ◽  
The Right

Radiation-induced intracranial aneurysm formation is a rare but life-threatening condition with a high mortality rate secondary to rupture of the aneurysm. Further-more, this condition can mimic tumour recurrence. Only 10 months after craniospinal radiation therapy for medulloblastoma, a 9-year-old boy developed a subarachnoid haemorrhage secondary to a ruptured saccular aneurysm arising from the distal part of the right anterior cerebral artery. The development of intracranial aneurysms and rupture following radiation damage of the arteries has been reported previously, but in no case as soon as 10 months after radiation therapy. It is important to diagnose these aneurysms as they can be successfully treated.

scholarly journals Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Alessio Arrivi ◽  
Gaetano Tanzilli ◽  
Paolo Emilio Puddu ◽  
Giovanni Truscelli ◽  
Marcello Dominici ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Early Recognition ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Catheterization Laboratory ◽  
Arterial Complication ◽  
Threatening Condition ◽  
Life Threatening ◽  
Previously Treated ◽  
Pathophysiologic Mechanisms

Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

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