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Title : 55 year-old male w/deep neck infection
Date : March 21, 2012
Contributed by
So Yeon Park, M.D, Samsung Medical Center, Korea
Patient History
Age/Sex 55 year-old male
Chief complaint fever with right side facial swelling
Present illness A 55-year –old male presented with a swelling in the neck and face of three weeks duration associated with high grade fever. He had no breathing problems or dental complaints. Despite therapy in local clinic in Malaysia, fever and swelling were persistent. For the further evaluation of his symptoms, he visited emergency department in Samsung Medical Center.
 
Past medical history

He had worked in Malaysiajungle for two years. He was a construction worker. He was previous healthy and had no history of diabetes.

* Socail history: He has usually drunk a bottle of soju per a week.


 


* Socail history: He has usually drunk a bottle of soju per a week.
 


 

Physical examination Initial vital signs were such as : BP 140/90, Heart rate 95, Respiratory rate 20, Body temperature 39.5℃. A soft diffuse swelling was noted on the right side of the neck and face. Examination of the oral cavity ahd throat revealed no abnormal findings.
Initial laboratory findings; WBC 14,310 (neutrophil 79%), Hb 14g/dL, platelets 351,000/mm3.
CRP 36.49 mg/L, AST/ALT 78/67 IU/L, CK 934 IU/L
Radiologic findings

Chest PA : no abnormal findings
Abdomen-Pelvic CT : It showed non- specific findings
Neck CT: 1. Clustered cystic lesion with surrounding significant
inflammation of the right temporal space. R/O Soft tissue
abscess
2. Widening of the right foramen ovale without significant
associated soft tissue lesion
Skull base MRI: 1. Highly suggested the deep neck space infection
with abscess formation, extending to the intracranial cavity.


 

Hospital course We prescribed ceftriaxone 2g intravenously every 12hr and metronidazole 500mg intravenously every 8hr. Despites of antibiotic therapy, he was progressed to septic shock. So neck exploration was performed. After drainage of pus, the wound was closed with a drainage tube into the neck space. The blood culture and aspirated pus culture showed gram negative bacilli. We changed antibiotics regimens to meropenem. However the patient died from multiorgan failure after 8 days.



 
Question - ID Case of the Week ( March 21, 2012 )
What is your presumptive diagnosis for this patient?
Please send us your answer to the following e-mail address ( nuove@ansorp.org ).
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The true answer of this case and a brief review will be presented next week.
The names of the persons who gave us a right answer will be also announced.


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