|
|
Post by mcclain on May 13, 2014 12:58:13 GMT -5
19-yr-old man presents with sore throat, vomiting x 1 last night, fevers to Tmax oral 102 F at urgent care, and generalized chills. Flu swabs, U/A, strep, mono negative at urgent care prior to arrival. Patient sent to ER because he has a history of Lemierre's Disease. What do you do for this patient?
|
|
|
|
Post by gigantor on May 13, 2014 22:57:54 GMT -5
Blood cultures and broad spectrum abx making sure to cover anaerobes? Don't know much about this syndrome other than it's related to sepsis with thrombophlebitis.
|
|
|
|
Post by mcclain on May 14, 2014 10:01:28 GMT -5
Yeah, it's a rare thing, but you have the right idea. Lemierre's is a septic thrombophlebitis with extension from tonsillitis/pharyngitis. Only other thing to add on would be ultrasound of the jugulars and subclavian to make sure you don't see a clot. My patient had had a clot in the left IJ that never fully resolved, but without new extension. A good ultrasound can demonstrate if the clot is new or old, and up to 40-50% of clots won't fully resolve and can be present on subsequent ultrasounds.
|
|
|
|
Post by slevittMD on May 14, 2014 12:27:19 GMT -5
You have inspired me to visit Wikipedia!
|
|
|
|
Post by mcclain on May 15, 2014 7:58:36 GMT -5
Not gonna lie, when this patient presented I did a quick consult to Dr. Google, who directed me to Dr. Wiki ;-) I also consulted Dr. UpToDate, though. Pepid had nothing about this stuff.
|
|
