N. Chapurin and A. Gelbard,
|
N Engl J Med 381:e15, August 29, 2019,
A previously healthy, fully immunized 48-year-old man presented to an urgent care clinic with a 3-day history of odynophagia, fever with temperatures of up to 40°C, and progressive shortness of breath. A lateral radiograph of the neck showed the “thumb sign” (Panel A, arrow), which was suggestive of an enlarged epiglottis. He was transferred to the emergency department, where a physical examination showed inspiratory stridor; he was sitting in the tripod position and was using accessory muscles for respiration. Immediate tracheostomy was performed while the patient was awake, and laryngoscopy revealed erythema, edema, and exudative inflammation of the epiglottis, with complete obstruction of the upper airway (Panel B). Intraoperative cultures from the epiglottis grew Streptococcus pyogenes. After 5 days of treatment with intravenous antibiotic agents targeting S. pyogenes, the tracheostomy tube was removed, and the patient was discharged home with a prescription for a 14-day course of oral amoxicillin–clavulanate. Repeat laryngoscopy 2 weeks after the initial presentation showed complete resolution of the infection (Panel C).
Nikita Chapurin, M.D.
Alexander Gelbard, M.D.
Vanderbilt University Medical Center, Nashville, TN
alexander.gelbard@vumc.org
 |
MEDICINE AND SOCIETY
|
J.H. Dunk and Others
|
N Engl J Med 381:778, August 22, 2019
|
CORRESPONDENCE
|
N. Lübke and Others
|
N Engl J Med 381:887, August 29, 2019
|
J. Wasiura and Others
|
N Engl J Med 381:584, August 8, 2019
|
C. Sorensen and R. Garcia-Trabanino
|
N Engl J Med 381:693, August 22, 2019
|
 Audio |  Comments |
G. McCarthy and A. Bernstein
|
N Engl J Med 381:696, August 22, 2019
|
| Audio | Comments |
IMAGES IN CLINICAL MEDICINE
|
S.Y. Tuteja and B. Forgacs
|
N Engl J Med 381:862, August 29, 2019
|
H. Lazareth and A. Karras
|
N Engl J Med 381:655, August 15, 2019
|
C. Hartnick
|
N Engl J Med 381:505, August 8, 2019
|
C.G. Streed and Others
|
N Engl J Med 381:500, August 8, 2019
|
| Comments |
IMAGES IN CLINICAL MEDICINE
|
S.Y. Tuteja and B. Forgacs
|
N Engl J Med 381:862, August 29, 2019
|
CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
|
M.A. Iaccarino and Others
|
N Engl J Med 381:863, August 29, 2019
|
HEALTH LAW, ETHICS, AND HUMAN RIGHTS
|
F.T. Bourgeois and A.S. Kesselheim
|
N Engl J Med 381:875, August 29, 2019
|
C.R. Lucey and Others
|
N Engl J Med 381:793, August 29, 2019
|
| Audio | Comments |
L. Beletsky and Others
|
N Engl J Med 381:796, August 29, 2019
|
| Audio | Comments |
R.L. Haffajee
|
N Engl J Med 381:699, August 22, 2019
|
O. Warren
|
N Engl J Med 381:600, August 15, 2019
|
K.R. Knight and Others
|
N Engl J Med 381:593, August 15, 2019
|
| Audio | Comments |
C.G. Streed and Others
|
N Engl J Med 381:500, August 8, 2019
|
| Comments |
CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
|
M.A. Iaccarino and Others
|
N Engl J Med 381:863, August 29, 2019
|
M. Nisavic and Others
|
N Engl J Med 381:763, August 22, 2019
|
CORRESPONDENCE
|
W. Deeb and Others
|
N Engl J Med 381:783, August 22, 2019
|
J.V. Vu and Others
|
N Engl J Med 381:680, August 15, 2019
|
J. Wasiura and Others
|
N Engl J Med 381:584, August 8, 2019
|
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου