Lemierre Syndrome: A Case Study Essay

PLAN: I have reviewed the chest x-rays available here and agree with the finding of bleb formation in the right and left upper lobes. Despite the fact that the patient has had a high INR, because of his history of tuberculosis and hemoptysis I believe obtaining sputum for TB is very, very important. We should rule out any other endobronchial lesions as the cause for his bleeding. I have discussed this matter with the patient and his wife. I have told them that there is the possibility of observing the condition by x-rays and repeated tests of his sputum. They understand that this is an option; however, they decided that because of concern regarding his repeated hemoptysis, they would consent to bronchoscopy. We will arrange for the patient to have a bronchoscopy done. He is off Coumadin.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

Another Consultation Report dated 12/06/2016, indicated that the claimant presented with exacerbation of COPD, acute bronchitis, and pseudomonas aeruginosa. The CT scan of the chest revealed bilateral lower lobe atelectatic changes, fibrosis, and a small 1 cm left lower lobe nodular density. A pulmonary consultation was recommended. His blood pressure was 142/79 mmHg. The physical examination revealed bilateral decreased breath sounds and scattered wheezes. His glucose was 189. DuoNeb, IV Solu-Medrol, and IV antibiotics were prescribed.

Her drug screen showed positive benzodiazepines and blood alcohol was negative. Troponins were negative. Also, her initial work up showed acute kidney injury with a creatinine of 1.84, and potassium of 5.8. Her chest x-ray showed small amount of infiltrate in the right lower lobe. The CT scan of the head did not show any acute changes. The abdominal CT scan showed constipation and 6 mm opacity in her bladder. She had an electroencephalogram (EEG) which revealed diffuse generalized nonspecific encephalopathy. In addition, there was slowing of the left hemisphere consistent with left intracerebral lesion. The assessment diagnoses were acute respiratory failure (ABG of 87.287, pCO2 of 45.2, pO2 of 380 and biacarbonate of 20 on vent settings), altered mental status, attempted suicide, infectious process, medication use, hyperglycemic nonketotic, and less likely cerebrovascular accident given that her CT scan of the head was normal. She was admitted to the Intensive Care Unit under the care of Dr. Modupe Kehinde. She was intubated for airway protection and remained intubated until 5/23/2016 (7 days). She was on ventilator and was given nutritional support

Mr. .J. is a 30 year old Caucasian male presented to the Emergency Department with symptoms of myalgia, fever, rash, swollen glands, leukopenia, and thrombocytopenia. Mr. J. reported fever and sore throat started about a week ago and the rash presented today. Mr. J. stated “I thought I had the flu but I am not feeling any better and now I have a rash, that’s why I decided to come to the E.D.”. (Health and Human Services panel, 2013)

Septicemia is an infection from a life threatening complication, such as pneumonia, kidney infections, a gunshot wound or have been severely burned. Septicemia is also known as bacteremia or blood poisoning, if it is left untreated it might progress into sepsis. Some symptoms pertaining to Septicemia are reduced urine volume, rapid respiration, fever and confusion to think clearly.

More than one million Americans get sepsis each year and twenty-eight to fifty percent of those people die. Sepsis is a medical condition caused by an overwhelming immune response to an infection that is often diagnosed too late. The inflammation caused from this unpredictable disease, leads to blood clots and leaky vessels, which results in weak blood flow, and damages organs. It usually stems from other infections as well as medical conditions in the body and is a major challenge in the ICU. Bacteria is the most common cause but viruses and fungi are causing factors as well. Since sepsis is so hard to diagnose, researchers are trying to find a way to catch this disease early.

Necrotizing fasciitis is an abnormal soft-tissue infection typically caused by toxin-producing, lethal bacteria, which is characterized by extensive fascial necrosis with corresponding sparing of underlying muscle as well as skin (Goldman, Schafer, and Cecil). This disease frequently targets diabetics, alcoholics, IV drug users, immunosuppressed patients, patients with peripheral vascular disease, and young, formerly healthy individuals. Necrotizing fasciitis is capable of occurring in any region of the body however it is commonly found in the abdominal wall, extremities, and perineum (Raffin, Green, and Dafoe 221). However, this pathogen is one of the most important bacterial pathogens in humans since it is the most frequent bacterial

The diagnosis of sepsis is obvious in Mr. M. W case. Since sepsis is a syndrome, Mr. M. W’s associated signs and symptoms need a carefully evaluated to avoid misdiagnosis. A disease conditions such as bacteria and cardiogenic shock may have overlapping signs and symptoms. Therefore, these signs and symptoms need to be supported with a source of infection. The clinical findings that justify the diagnosis sepsis will be discussed before identifying and discussing the source of Mr. M. W’s infection.

The criteria for diagnosis entails a child that has a fever for 5 days plus four out of five of the other criteria: bilateral conjunctiva injection without exudate, polymorphous rash, inflammatory changes in the lips and oral cavity, changes in extremities (peripheral edema, erythema of palms and soles), and cervical lymphadenopathy that is usually unilateral, anterior cervical (Burns, Dunn, Brady, Starr, Blosser, 2013). Since the ER already performed cultures, a urine study, CBC, and CMP, which were all negative, the next blood work that would be beneficial is a CRP and ESR to check the extent of inflammation. The results of the CRP and ESR can help guide the management of the patient to see if treatment is necessary. The condition may only need to be monitored with a series of echocardiograms, or treatment with IVIG may become necessary depending on the results of the echocardiogram. No matter if IVIG treatment is needed, an echocardiogram should be performed as soon as a diagnosis is made, and at two weeks and six to eight weeks after the onset of the fever to evaluate coronary, myocardial, and pericardial inflammation (Burns, Dunn, Brady, Starr, Blosser,

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

Case Description: A 25 year old healthy male who is a very active running back in the sport of football came to the emergency room. The patient has a history of previous

"The common clinical features among the case-patients included a prodromial illness of fever, chills, and myalgia. The prodrome was followed by dyspnea, cough, throbocytopenia, severe hemodynamic instability, neutrophilid with immature forms, atypical lymphocytes, elevated serum levels of lactate dehydrogenase. There was a high mortality rate, approximately eighty percent in the initial group of patients, the chest x-ray examinations revealed a diffuse, interstitial infiltrate that resembled that observed in patients with adult respiratory distress syndrome (ARDS), which is a common pattern in patients

History of Present Illness: Mr. A. O. a 66 year-old-African American male came in the clinic for a monthly routine follow up visit complaining of severe cluster frontal headaches that radiates to his left eye, pain level eight out of ten, on and off for three days lasting for 30 to 45 minutes. He stated that he takes Tylenol 1000mg orally every eight hours with mild relieve, and will like his blood pressure medications increased. Also, he complained of edema to the upper and lower extremities, and right hand pain when he tries to make a fist. However, he denied shortness of breath,