Diagnosis of Lemierre’s Syndrome by Bedside Sonography

Abstract

Diagnosis of Lemierre's Syndrome by Bedside SonographyAn 18-year-old male with no medical history presented to the emergency department (ED) with a 10-day history of fever, sore throat, and cough and a 2-day history of increasing headache, eye pain, a decrease in alertness, and neck pain.The patient was seen in the same ED 6 days earlier with a discharge diagnosis of influenza.The patient's initial vital signs were as follows: temperature 102.8F, pulse 123 beats min, respiratory rate 28 breaths min, blood pressure 101 59 mm Hg, and peripheral oxygen saturation 96% on room air, improving to 100% on 2 L min oxygen via nasal cannula.Physical exam revealed a well-developed, well-nourished African American male in moderate distress due to pain.He was arousable with gentle stimulation but somewhat inappropriate in his verbal responses.He had mild photophobia, nasal congestion, a minimally erythematous posterior oropharynx with cobblestoning, shotty anterior cervical adenopathy, moderate tenderness of his anterolateral neck (right greater than left), and nuchal rigidity.There were coarse rhonchi in the right lung field.There were no other abnormalities on exam.A noncontrast computed tomography (CT) of the brain was interpreted by an attending radiologist as unremarkable.A lumbar puncture revealed pleocytosis with 21 white blood cells mL with 88% neutrophils.Chest radiography revealed a right lower lobe infiltrate.Blood work demonstrated an elevated white blood cell count (16.32 10 3 /lL) with bandemia (23%) and thrombocytopenia (platelet count 26 10 3 /lL).Mild azotemia and transaminitis were also noted.