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Peritonsillar and neck cellulitis - Lemierre syndrome

Case contributed by Charlie Chia-Tsong Hsu
Diagnosis almost certain

Presentation

16 year old female presented to the emergency with left jaw and neck swelling and trismus. Immediate history of tonsillitis for past 4 days, initially managed with oral antibiotics.

Patient Data

Age: 16 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Upper airway compromise with gross tonsil and uvula swelling subsequently requiring intubation. 

Peritonsillar and neck cellulitis: Fluid (marked by arrows) in the peritonsillar space extending superiorly into the parapharyngeal space and medially into the pre-epiglottic space. Swelling of the left parotid gland (marked by asterisks), masticatory muscles, and other soft tissues of the neck.

Jugular thrombophlebitis: Occlusive thrombus in the left external jugular vein (marked by carets) extending into the retromandibular vein with enhancement at the margins of the vein.

Lymphadenopathy: Enlarged cervical lymph nodes. 

Systemic sepsis: Raised white cell count, CRP >200, tachycardia, hypotension and respiratory acidosis.

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