A common complaint... a rare disease!

alkiviadis.1961 shared this article with you from Inoreader A common complaint... a rare disease! Via Online First A 2-year-old previously well child presented to the emergency department with temperatures and lethargy. He was pale and looked unwell. He received a fluid bolus and was commenced on intravenous ceftriaxone. Pus was discharging from his left ear with postauricular swelling and erythema. Given clinical concerns, urgent neuroimaging was arranged. Question 1 What does the CT scan of head show (figure 1)? Figure 1 Enhanced CT showing external and middle ear infection with skull base osteomyelitis. Acute subdural collection Acute mastoiditis secondary to sinusitis Enhanced cerebral lesions Meningitis with abscess formation Middle ear infection with skull base osteomyelitis A subsequent MRI scan was performed (figure 2). Figure 2 MRI shows thrombus in left jugular vein, and MRA demonstrates occlusion of left internal carotid artery secondary to carotid sheath infection. Question 2 What do these two images show? Left jugular vein dissection with subdural haematoma Left jugular vein thrombus and carotid artery occlusion Posterior fossa tumour Right sided posterior communicating artery aneurysm Skull base abscess Question 3 What is the most likely diagnosis? Acute mastoiditis secondary to chronic sinusitis Cerebral tuberculosis (TB) Hereditary thrombophilia (protein S deficiency) Lemierre's syndrome Non-accidental head trauma (NAI) Question 4 Wha t is the most commonly identified organism in this syndrome? Candida albicans Fusobacterium necrophorum Haemophilus influenza Staphylococcus aureus Streptococcus pyogenes Answers can be found on page XX. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.