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

A-19-Year-Old-College-Student-With-Headache,-Photo

Pdf Summary

The document presents a medical case study of a 19-year-old college student who experiences a two-week history of headache, photophobia, neck stiffness, low-grade fevers, malaise, and dark urine, progressing to respiratory distress and minimal responsiveness. Upon admission, he is found to have hypotension, tachycardia, fever, leukocytosis, impaired renal function, and eventually goes into septic shock, necessitating intensive care and intubation.<br /><br />Diagnostic workup reveals elevated white blood cell count, low platelet and hemoglobin levels, renal impairment with increased BUN and creatinine, elevated bilirubin, proteinuria, and hematuria, yet cerebrospinal fluid studies are normal. Blood cultures identify Fusobacterium necrophorum, an anaerobic gram-negative bacillus often involved in Lemierre syndrome.<br /><br />Initial imaging shows pulmonary nodules consistent with septic emboli and a liver lesion. Further tests, including a bone marrow biopsy, reveal hemophagocytic lymphohistiocytosis (HLH), indicated by significantly elevated ferritin and increased histiocytosis. The patient's condition is thought to originate from gastrointestinal Fusobacterium necrophorum infection, not the common pathway of pharyngitis or jugular vein thrombophlebitis.<br /><br />The document discusses the pathogen's history, occurrence, and treatment. Fusobacterium necrophorum causes infections like pharyngitis, peritonsillar abscesses, bacteremia, and often serious conditions like septic emboli and hepatic abscess. Familiar treatment involves broad-spectrum antibiotics and may include surgical drainage.<br /><br />The patient is treated with dexamethasone for HLH, and his condition improves with reduced fever, heart rate, and inflammation markers. He recovers following drainage of the hepatic abscess, is extubated, and later discharged on antibiotics and a dexamethasone taper, highlighting the necessity for awareness of Fusobacterium infections and HLH in similar clinical presentations.

Keywords

Fusobacterium necrophorum

Lemierre syndrome

hemophagocytic lymphohistiocytosis

septic shock

broad-spectrum antibiotics

HLH treatment

septic emboli

hepatic abscess

dexamethasone

gastrointestinal infection