RyanCaleb
16.11.2017, 09:54
A 14-year-old female began having nasal congestion, frontal headache and subjective fever, and her parent thought she had an upper respiratory tract infection and treated her symptomatically. She was given ibuprofen for the headache, without much relief, and 2 days later, as the symptoms worsened, she went to her local emergency room.
There, she was diagnosed with a sinus infection and treated with amoxicillin plus clavulanate (Augmentin). However, after 2 more days, her symptoms continued to worsen with the inclusion of some painful periorbital swelling with erythema of the right eye, and she went to her primary provider who admitted her for the treatment of preseptal cellulitis with IV ceftriaxone plus clindamycin. Her clinical condition continued to worsen during the next 24 hours, and an admitting blood culture was reported positive for gram-positive cocci in chains; therefore, she was transferred to the regional medical center pediatric ICU for further management.
Examination on arrival revealed normal vital signs and a generally alert and normal adolescent female with painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead (Figures 1 and 2). She also had a slightly blood-tinged nasal discharge from her right nostril. Her eye and the rest of her otolaryngologic and neurologic exam were normal. There were no other pertinent findings on the rest of her examination.
Figure 1: The patient has painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead.
Figures 1-2: The patient has painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead.
Figure 2: The patient has painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead.
Her complete blood count revealed a white blood cell count of 20,400, with 78% neutrophils. A computed tomography scan on admission is shown in Figures 3 and 4. Magnetic resonance imaging on the same day is shown in Figures 5 and 6 (representative T2 images).
Figure 3: A computed tomography scan on admission. Figure 4: A computed tomography scan on admission.
Figures 3-4: A computed tomography scan on admission.
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There, she was diagnosed with a sinus infection and treated with amoxicillin plus clavulanate (Augmentin). However, after 2 more days, her symptoms continued to worsen with the inclusion of some painful periorbital swelling with erythema of the right eye, and she went to her primary provider who admitted her for the treatment of preseptal cellulitis with IV ceftriaxone plus clindamycin. Her clinical condition continued to worsen during the next 24 hours, and an admitting blood culture was reported positive for gram-positive cocci in chains; therefore, she was transferred to the regional medical center pediatric ICU for further management.
Examination on arrival revealed normal vital signs and a generally alert and normal adolescent female with painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead (Figures 1 and 2). She also had a slightly blood-tinged nasal discharge from her right nostril. Her eye and the rest of her otolaryngologic and neurologic exam were normal. There were no other pertinent findings on the rest of her examination.
Figure 1: The patient has painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead.
Figures 1-2: The patient has painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead.
Figure 2: The patient has painful swelling and erythema of the area around her right eye and marked swelling with severe pain over the forehead.
Her complete blood count revealed a white blood cell count of 20,400, with 78% neutrophils. A computed tomography scan on admission is shown in Figures 3 and 4. Magnetic resonance imaging on the same day is shown in Figures 5 and 6 (representative T2 images).
Figure 3: A computed tomography scan on admission. Figure 4: A computed tomography scan on admission.
Figures 3-4: A computed tomography scan on admission.
For more you can check
[moderated]