Peritonsillar and neck cellulitis - Lemierre syndrome
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.
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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.