At 16:55 24/02/2010, you wrote:
>On Tue, Feb 23, 2010 at 3:54 PM, Julian Bradley
><[log in to unmask]> wrote:
> > Based (loosely) on an actual case (with patient consent), where I
> am not the
> > GP.
>
> > couple of weeks
> > some sore throat / neck pain and discomfort with swallowing.
> > Tachycardia 115 at rest - and some suggestion this may have persisted
> > through illness
> > Low grade fever confirmed
> >
>
>
>One of those tricky ones not fitting a common/clear pattern.....easy
>to say 'I dunno, but likely ok' - let's face it we see loads of odd
>headaches, sore throats, malaise.
>
>But there are clues to that fact that she may be 'big sick' (as
>opposed to 'little sick')
>
> > couple of weeks
> > some sore throat / neck pain and discomfort with swallowing.
> > Tachycardia 115 at rest - and some suggestion this may have persisted
> > through illness
> > Low grade fever confirmed
> >
>
>.......I highly commend the notion of big vs little sick by the
>way.....useful in teaching, we use it in the wilderness medicine
>programs.
>
>Initial guess is perhaps something like Lemierre's syndrome /
>peri-tonsillar cellulitis or similar. Other thoughts - mediastinitis?
>
>Jel
Just in case someone else on the list hasn't heard of Lemierre's
syndrome - http://en.wikipedia.org/wiki/Lemierre's_syndrome
No skin symptoms complained of by patient, none visible on face, neck or chest.
HS in aortic and parasternal areas normal, bra not removed.
Patient initially presented on a Friday pm - lets say after 4pm.
Of course y'all know this is not going to be "typical" because I'm
writing about it, but in practical management terms a bit of a challenge.
I note thoughts on FBC, ESR, CRP, Blood Cultures, and various
virology tests (EB, CMV etc) - of course none available without
hospital referral on a Friday evening.
Part 2 will follow, this is just some clarification of part 1.
Julian
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