| Identifier |
walsh_2022_s2_c1 |
| Title |
Just a Flu? |
| Creator |
Lily "Tali" Okrent Smolar, Veronika Yehezkeli, Fani Segev, Feda Fanadka, Sachin Kedar, Yehoshua Almog |
| Subject |
jugular veins, infectious disease, venous sinus thrombosis, proptosis, eye movements |
| History |
A thirteen-year-old boy with no significant past medical history presented to the pediatric emergency department (ED) with; progressive right eyelid swelling, decreased appetite, general malaise and obtundation. A week prior to presentation, he; had flu like illness with fever, headache, ear pain, nasal congestion, and left upper eyelid swelling. On presentation, he was; pale, diaphoretic, and lethargic. He also had halitosis, positional neck pain, and diplopia. Examination in the ED revealed; relative bradycardia, fever, right-sided proptosis (image 1), and right eyelid swelling. Ophthalmoscopic examination showed; blurred right disc margins. Neuro-ophthalmological examination showed extraocular muscle limitation in multiple gaze; positions, a right RAPD and mild anisocoria (right pupil larger than the left). No bruits were auscultated over the orbit.; Bloodwork was significant for left-shift leukocytosis (15,700/microL) and a CRP of 6.9mg/dL, AST 96U/L, ALT 98U/L, and Ddimer; 2483ng/mL. Contrast-enhanced head CT showed hyperdensities in the mastoid and sphenoid sinuses (images 1) and; both ear canals. He had widespread intracranial thrombophlebitis in bilateral internal jugular veins (image 2), bilateral; cavernous sinus (image 3), right superior ophthalmic vein (image 4), and superior (image 5) and inferior petrosal sinuses.; Various sequences of MRI head and neck showed widespread soft tissue inflammation and small abscesses in multiple softtissue; planes (image 6), and intracranial inflammation (images 7+8) with a developing left cerebellar abscess (images 9+10). |
| Disease/Diagnosis |
Lemierre's syndrome/post-anginal sepsis/necrobacillosis - The diagnosis of Lemierre's syndrome requires a high index of; suspicion and urgent imaging. Timely diagnosis is critical to institute appropriate treatment, which includes multidisciplinary; management, to preserve life and prevent long term visual sequelae. |
| Date |
2022-02 |
| References |
Ramirez, Susan, et al. "Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a; Children's Hospital." Pediatrics112.5 (2003): e380-e380.; Liu, Alice, et al. "Severe case of Lemierre syndrome with multiple neurological and ophthalmological sequelae." BMJ Case; Reports CP 14.8 (2021): e244669.; Akiyama, Kosuke, et al. "Blindness caused by septic superior ophthalmic vein thrombosis in a Lemierre Syndrome; variant." Auris Nasus Larynx 40.5 (2013): 493-496.; Habek, M., Petravić, D., Ozretić, D., & Brinar, V. V. (2009). Horner syndrome due to jugular vein thrombosis (Lemierre; syndrome). Case Reports, 2009, bcr2007124479.; Vu, Vincent N., Peter J. Savino, and Shira L. Robbins. "Bilateral abducens nerve palsy due to septic thrombophlebitis."; American journal of ophthalmology case reports 16 (2019): 100566. |
| Format |
application/pdf |
| Type |
Text |
| Source |
54th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 2022: Walsh Session II |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2022. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6d5b34r |
| Contributor Primary |
Lily "Tali" Okrent Smolar, MD |
| Contributor Secondary |
Veronika Yehezkeli, Fani Segev, Feda Fanadka, Sachin Kedar, Yehoshua Almog |
| Setname |
ehsl_novel_fbw |
| ID |
2100234 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6d5b34r |
