CHEST Guidelines-A-19-Year-Old-College-Student-With-Headache,-Photo (2)

A-19-Year-Old-College-Student-With-Headache,-Photo (2)

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The article presents the case of a 19-year-old college student who was admitted to the emergency department with a 2-week history of headache, photophobia, and neck stiffness, along with symptoms such as low-grade fever and dark urine. Upon examination, he had respiratory distress and required intubation. Treatment included broad-spectrum antibiotics and vasopressors due to hypotension and persistent symptoms such as fever and leukocytosis.<br /><br />Upon transfer to another hospital, diagnostic studies including blood cultures revealed a Fusobacterium necrophorum infection. Imaging studies identified septic pulmonary emboli and a hepatic abscess. The patient's worsening condition, including renal failure and cytopenias, led to a diagnosis of secondary hemophagocytic lymphohistiocytosis (HLH).<br /><br />Fusobacterium necrophorum is a gram-negative anaerobic bacterium often found in the gastrointestinal tract and responsible for invasive infections. One notable presentation of infection is known as Lemierre syndrome, which involves septic thrombophlebitis of the internal jugular vein. However, in this case, the infection’s primary source was suspected to be the gastrointestinal tract.<br /><br />Treatment guidelines for Fusobacterium infections include carbapenem antibiotics, sometimes in combination with metronidazole or beta-lactamase inhibitor antibiotics, along with surgical interventions if necessary. For secondary HLH, treatment involves addressing the underlying condition and potentially administering corticosteroids and etoposide. <br /><br />The patient, after dexamethasone treatment, showed clinical improvement, with reduced fevers, and was eventually extubated, weaned off vasopressors, and discharged with plans to continue antibiotics and a tapered steroid regimen at home. This case emphasizes the importance of recognizing and treating both Fusobacterium infections and secondary HLH to prevent severe complications.

Keywords

Fusobacterium necrophorum

secondary hemophagocytic lymphohistiocytosis

Lemierre syndrome

broad-spectrum antibiotics

septic pulmonary emboli

hepatic abscess

carbapenem antibiotics

dexamethasone treatment

intubation

photophobia