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necrobacillosis; Lemierre's disease; postanginal sepsis

Etiology: - Fusobacterium necrophorum, in conjunction with other bacterial flora Epidemiology: - more common in adolescents & young adults Pathology: 1) infection of the tonsils & pharynx 2) may spread to subcutaneous tissues of jaw & neck Clinical manifestations: 1) starts as severe exudative pharyngitis 2) pain & swelling at the angle of the jaw 3) tenderness over the sternocleidomastoid muscle 4) symptoms may spread 5) fever 6) pleuritic chest pain & productive cough (case report) [2] Laboratory: - anaerobic blood culture - SaO2 of 88% (case report) [2] Radiology: - chest X-ray (case report) [2] - consolidation in the middle & upper lung - chest CT (case report) [2] - multiple cavitary lesions - loculated left pleural effusion - contrast enhanced CT of neck - CT pulmonary angiography computed tomography images [2] Complications: 1) septic thrombophlebitis of the internal jugular vein 2) septic pulmonary embolism 3) death Management: - drainage of pleural effusion - intravenous ceftriaxone & oral metronidazole [2]

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Walkty A, EmbilJ. Lemierre's Syndrome. N Engl J Med 2019; 380:e16. March 21. PMID: 30893539 https://www.nejm.org/doi/full/10.1056/NEJMicm1808378