(BMJ)—A 61-yo man presented w/ neck swelling after starting abx for cough, fever and sore throat a few days prior. Exam: afebrile, hard 9x4 cm mobile mass on right side of neck. What is the dx?
Lemierre’s syndrome
Tuberculosis
Mononucleosis
Q fever
Ludwig’s angina
You are correct. Lemierre’s syndrome (LS), also known as anaerobic postanginal septicemia, occurs after infxn of the palatine tonsils and peritonsillar tissue. Other, rarer locations of infxn are the lung, middle ear, mastoid, teeth and sinuses. Local invasion and septic thrombophlebitis of the internal jugular vein are seen after primary infxn. The 2 most common isolates are Fusobacterium necrophorum and Klebsiella pneumoniae. LS usually manifests w/ sore throat, fever, rigors, and unilateral neck pain and swelling in young, healthy individuals. Dx is confirmed by Doppler U/S or CT and blood cx.
(BMJ)—A 77-yo man presented w/ a dorsal L-hand ulcer 10 days after reaching into a bush. He thought he had a cat bite. The ulcer worsened despite oral abx, IV abx, surgical debridement, and skin graft. Within days, bluish ulcerative nodules developed at graft margins. What is the dx?
Mycobacterium scrofulaceum
Sporotrichosis
Neutrophilic dermatosis
Squamous cell carcinoma
Dermatophilosis
You are correct. Neutrophilic dermatosis was diagnosed clinically and resolved rapidly w/ oral steroids. A rare idiopathic reactive inflammatory condition, neutrophilic dermatosis mimics infection but does not respond to abx or debridement. Some cases resolve spontaneously, although many persist. About 15% are associated with hematological malignancy.