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A Pain In The Neck - Page #1
 

Author: Matthew Usevitch, MD
Co Author #1: Nicole Thomas, DO, Gina Bertelli, DO
Co Author #2: Jana Qiao, MD, Sarah Nullmeyer, MD
Co Author #3: Sarah Nullmeyer, MD, Christopher Miles, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Caitlin Lewis, MD

Patient Presentation:
A 23-year-old collegiate tennis player with a history of ADHD and a recent hospitalization for sepsis and myocarditis presented to the Emergency Room with malaise and left-sided neck pain.

History:
Since discharge three days prior, he had intermittent fevers to 102 F, left neck and facial pain, trismus, and acute onset dyspnea with pleuritic chest pain. He denied voice changes, dysphagia, confusion, weakness, numbness, or focal neurologic deficits. Chart review revealed the patient was admitted for presumed viral myocarditis complicated by acute heart failure (ejection fraction 20-25%) and Streptococcus dysgalactiae bacteremia. He had been discharged on metoprolol, losartan, and furosemide for his heart failure and oral cefpodoxime for his bacteremia. He reported adherence with his regimen since discharge, though notably he had been switched to Augmentin due to new growth of Fusobacterium necrophorum on his blood cultures.

Physical Exam:
On arrival, patient was febrile to 102.4 F, tachycardic to 134 bpm, tachypneic to 27 bpm, normotensive, and requiring 2L of oxygen to maintain SpO2 greater than 90%. He was ill-appearing with dry mucous membranes. He had left-sided tender anterior cervical and submandibular lymphadenopathy. There was no peritonsillar edema, exudate, or oropharyngeal erythema. Heart sounds were tachycardic with regular rhythm and no murmurs or rubs. He had increased work of breathing with supraclavicular retractions but no focal findings on auscultation. His abdomen was tender but without rebound, guarding, hepatosplenomegaly, or masses. He had no peripheral edema or skin changes. His neurological exam was intact.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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