ro13-9904 and Neck-Pain

Topics: Adult; Analgesics, Opioid; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Clindamycin; Epstein-Barr Virus Infections; Fever; Humans; Lemierre Syndrome; Lymphadenopathy; Male; Neck Pain; Positron Emission Tomography Computed Tomography; Streptococcus anginosus; Tilidine; Young Adult

Topics: Amoxicillin; Ceftriaxone; Central Nervous System Cysts; Diagnosis; Fever; Humans; Infant; Male; Meningitis, Aseptic; Neck Pain; Streptococcal Infections; Vaccination Refusal; Vancomycin

Topics: Administration, Intravenous; Adolescent; Anti-Bacterial Agents; Brain; Ceftriaxone; Central Nervous System Viral Diseases; Diagnosis, Differential; Diarrhea; Flushing; Guillain-Barre Syndrome; Headache; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Irritable Mood; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Myelitis; Neck Pain; Paresthesia; Peroneal Neuropathies; Pneumonia, Bacterial; Reflex, Abnormal; Spinal Cord; Sweating; Urinary Retention; West Nile Fever

A 38-year-old woman with Crohn's disease, under immunosuppressive therapy, was referred to the emergency department for severe progressive neck pain and fever, with 1 week of evolution. She was unable to perform neck mobilisation due to the intense pain aroused. She referred dysphagia. Oral cavity, oropharynx, hypopharynx and larynx showed no alterations. She had an increased C reactive protein. Central nervous system infections were excluded by lumbar puncture. CT was normal. Only MRI showed T2 hyperintensity of the retropharyngeal and prevertebral soft tissues of the neck without signs of abscess. The patient was treated with broad spectrum antibiotics. Complications of deep neck infection include abscess formation, venous thrombosis and mediastinitis. In this case, no complications occurred. A high degree of clinical suspicion is essential as deep neck infections need to be promptly diagnosed and treated given their rapidly progressive character, especially in immunocompromised patients.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Cellulitis; Central Nervous System Infections; Clindamycin; Crohn Disease; Diagnosis, Differential; Early Medical Intervention; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Neck; Neck Pain; Retropharyngeal Abscess; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Brachial Plexus Neuritis; Ceftriaxone; Chronic Disease; Disease Progression; Electromyography; Humans; Lyme Disease; Magnetic Resonance Imaging; Monitoring, Physiologic; Neck Pain; Prognosis; Risk Assessment; Serologic Tests; Severity of Illness Index; Ultrasonography, Doppler

Topics: Abscess; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Diagnosis, Differential; Humans; Male; Neck Pain; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Thyroid Diseases; Thyroid Gland; Tomography, X-Ray Computed; Ultrasonography

A young man presented with recent-onset non-specific symptoms like headache, sleepiness and weight loss, interfering with normal daily life. Physical and biochemical irregularities were absent. Because extensive examination by neurologist and psychiatrist including brain imaging did not reveal any clues, the complaints were initially considered psychosomatic. As the symptoms deteriorated with ongoing weight loss, the patient was re-admitted to the hospital. Again, extensive additional investigation did not reveal any abnormalities. Because of previous exposition to the woods Lyme serology was determined. Surprisingly, it appeared to be a remarkable presentation of acute Lyme neuroborreliosis which was successfully treated with ceftriaxon. Clinicians must be aware of the fact that this severe illness can present without any typical symptoms.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Dizziness; Headache; Humans; Lyme Neuroborreliosis; Male; Medical History Taking; Neck Pain; Photosensitivity Disorders; Weight Loss

Here, we demonstrate a first case of tick-borne encephalitis (TBE) associated with an isolated reversible splenial corpus callosum lesion (IRSL) and highlight the wide range of different clinical entities in which such alterations have been observed. A 42-year-old man showed fever, cephalgia and mild disturbance of coordination and gait. Diagnosis was ascertained by slight CSF-pleiocytosis and positive TBE-IgG as well as by positive intrathekal specific antibody index on follow-up. MRI demonstrated a single ovoid hyperintensity in T2 and DWI with reduction in ADC in the splenium of corpus callosum which was abrogated in follow-up after 6 weeks. Most entities of IRSL presented with excellent prognosis, including our novel case of TBE. We discuss different possible pathomechanisms and the so far unexplained propensity of the splenium for such alterations. Clinicians should be familiar with this phenomenon to avoid unnecessary diagnostic or therapeutic efforts.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Ataxia; Ceftriaxone; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Encephalitis, Tick-Borne; Fever; Gait Disorders, Neurologic; Headache; Humans; Image Processing, Computer-Assisted; Immunoglobulin G; Magnetic Resonance Imaging; Male; Neck Pain

Topics: Anti-Bacterial Agents; Brain Stem; Ceftriaxone; Cerebellar Diseases; Diagnosis, Differential; Diencephalon; Disease Progression; Fatigue; Female; Humans; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Mesencephalon; Middle Aged; Neck Pain; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cervical Vertebrae; Epidural Abscess; Fever; HIV Infections; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Neck Pain

Topics: Adult; Anti-Bacterial Agents; Antibodies; Ataxia; Borrelia burgdorferi; Brain; Ceftriaxone; Female; Humans; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Nausea; Neck Pain; Norway; Opsoclonus-Myoclonus Syndrome; Time; Tomography, X-Ray Computed; Treatment Outcome

In the pediatric literature, only 1 case of cervical spondylodiscitis from an ingested foreign body is reported and this was caused by a blunt radiolucent foreign body. The authors now describe a unique case of a 13-year-old teenaged boy who presented with neck pain 6 days after accidental ingestion of a sewing pin. Uncomplicated removal of this pin was followed in 36 days by the development of cervical spondylodiscitis that failed conservative management and required surgical debridement and arthrodesis. Physicians should be aware of the possibility of this complication in any patient that presents with neck pain after foreign body ingestion.

Topics: Accidents; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bone Plates; Ceftriaxone; Cervical Vertebrae; Clindamycin; Combined Modality Therapy; Deglutition Disorders; Discitis; Diskectomy; Emergencies; Equipment Contamination; Follow-Up Studies; Foreign Bodies; Humans; Laryngoscopy; Larynx; Male; Neck Pain; Oxacillin; Paresthesia; Penicillanic Acid; Pharynx; Piperacillin; Piperacillin, Tazobactam Drug Combination; Radiography; Recurrence; Retropharyngeal Abscess; Spinal Fusion; Vancomycin; Wounds, Penetrating