Peritonsillar and neck cellulitis - Lemierre syndrome

Case contributed by Dr Charlie Chia-Tsong Hsu

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
Gender: Female

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

Peritonsillar and neck cellulitis: Peritonsillar fluid in the submandibular space extending superiorly into the parapharyngeal space and medially into the pre-epiglottis space.  Swelling of the left masticator muscle, partoid gland and the soft tissue of the neck.

Jugular thrombophlebitis: Occlusive thrombus in the left external jugular vein 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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Case information

rID: 20527
Case created: 24th Nov 2012
Last edited: 19th Dec 2015
System: Head & Neck
Inclusion in quiz mode: Included

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