Acute neck infection
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A fully immunized, previously well 11-month-old girl presented with a 4-day history of fever, coryza, and increasingly frequent respiratory grunting. On examination, she was febrile (temperature, 38.2°C), and had tachycardia and hypotension. She also had tachypnea, with mild stridor, and there was a fullness on the right side of her neck that developed on the day of presentation (Panel A). Lateral neck radiography revealed additional prevertebral swelling (Panel B, arrow), and an ultrasound scan showed multiple enlarged lymph nodes but no retropharyngeal abscess. The patient had neutropenia and an elevated level of C-reactive protein. She was treated with ceftriaxone, but her condition rapidly deteriorated, with progressive neck swelling, bilateral pleural effusions, and hepatosplenomegaly.The development of significant cervical lymphadenopathy concurrently with symptoms of shock appeared to be part of the initial group A streptococcal septic shock syndrome, with subsequent development of pleural effusions and organomegaly...

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Dr. M●. S●●●●●l I●●●m S●●●n and 5 others like this
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