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Τρίτη 10 Νοεμβρίου 2020

A common complaint... a rare disease!

alkiviadis.1961 shared this article with you from Inoreader

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A 2-year-old previously well child presented to the emergency department with temperatures and lethargy. He was pale and looked unwell. He received a fluid bolus and was commenced on intravenous ceftriaxone. Pus was discharging from his left ear with postauricular swelling and erythema. Given clinical concerns, urgent neuroimaging was arranged.

Question 1

What does the CT scan of head show (figure 1)?

Figure 1

Enhanced CT showing external and middle ear infection with skull base osteomyelitis.

Acute subdural collection

Acute mastoiditis secondary to sinusitis

Enhanced cerebral lesions

Meningitis with abscess formation

Middle ear infection with skull base osteomyelitis

A subsequent MRI scan was performed (figure 2).

Figure 2

MRI shows thrombus in left jugular vein, and MRA demonstrates occlusion of left internal carotid artery secondary to carotid sheath infection.

Question 2

What do these two images show?

Left jugular vein dissection with subdural haematoma

Left jugular vein thrombus and carotid artery occlusion

Posterior fossa tumour

Right sided posterior communicating artery aneurysm

Skull base abscess

Question 3

What is the most likely diagnosis?

Acute mastoiditis secondary to chronic sinusitis

Cerebral tuberculosis (TB)

Hereditary thrombophilia (protein S deficiency)

Lemierre's syndrome

Non-accidental head trauma (NAI)

Question 4

Wha t is the most commonly identified organism in this syndrome?

Candida albicans

Fusobacterium necrophorum

Haemophilus influenza

Staphylococcus aureus

Streptococcus pyogenes

Answers can be found on page XX.

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