Category Archives: Morning Report

Lemierre’s Syndrome

Yesterday we discussed the case of a young man with no past medical history who presented with subacute onset progressive unilateral facial swelling and B symptoms unresponsive to oral antibiotics

Our differential diagnosis included infectious etiologies (bacterial abscess, EBV, Mumps, TB lymphadenitis), malignancy (lymphoma, squamous cell carcinoma, Burkhitt’s lymphoma), and Lemierre’s syndrome (thrombophlebitis of IJ).

On CT Neck, patient was found to have multiple mandibular abscesses, and apical lung cavitary lesions concerning for septic emboli. While neck ultrasound did not find a thrombus within the internal jugular vein, given cavitary lesions in the lungs, Lemierre’s syndrome was thought to have been the diagnosis.

Metabolic encephalopathy due to electrolyte derangements secondary to bulimia nervosa

Today we discussed the case of a young woman with history of bulimia nervosa and secondary ESRD due to recurrent AKIs, who presented with subacute encephalopathy, found to have metabolic alkalosis with partial compensation with respiratory acidosis in addition to concomitant anion gap metabolic acidosis.

  1. Metabolic Alkalosis – due to emesis
  2. Respiratory Acidosis- compensatory
  3. Anion gap metabolic acidosis – Renal failure, given lactate, and beta-hydroxybutyrate were normal.

In this case, we saw that after SLEDD treatment, patient’s metabolic alkalosis and anion gap metabolic acidosis resolved and she was left with her compensatory respiratory acidosis.

A thanks to former chief resident, Dr. Saloni Kumar for her teaching of this material to us back in 2017!

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