BMJ case reports
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Case Reports
Clival osteomyelitis and hypoglossal nerve palsy--rare complications of Lemierre's syndrome.
An increasingly reported entity, Lemierre's syndrome classically presents with a recent oropharyngeal infection, internal jugular vein thrombosis and the presence of anaerobic organisms such as Fusobacterium necrophorum. The authors report a normally fit and well 17-year-old boy who presented with severe sepsis following a 5-day history of a sore throat, myalgia and neck stiffness requiring intensive care admission. ⋯ The patient improved on meropenem and metronidazole and was warfarinised for his cavernous sinus thrombosis. He has an on-going left-sided hypoglossal (XIIth) nerve palsy.
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A 22-year-old man experiencing infrequent episodes of abdominal pain, distension, non-bilious vomiting and constipation, was diagnosed with malrotation of the gut. He was treated conservatively over the past 10 years. He was referred to our hospital owing to recent aggravation of symptoms. ⋯ The large bowel was placed on the right side and small bowel was placed on the left. Appendectomy and feeding jejunostomy were performed. Thorough analysis (clinicoradiological) is necessary before considering conservative management in patients known to harbour a congenital anomaly of the gut.
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A 61-year-old woman sustained multiple fractures secondary to the tonic clonic muscular contractions of a seizure. Her injuries included: bilateral proximal humerus posterior fracture dislocations, manubrium fracture, unstable sixth thoracic vertebrae crush fracture, bilateral acetabular fractures and a left femoral neck fracture. ⋯ The lack of history of high-energy trauma can lead to a delay in diagnosis. Rarely, the combination and magnitude of these injuries can be life-threatening.