Nicolau Syndrome: A Rare Complication following Intramuscular Injection

A 5-year-old boy presented to the emergency department with a 2-day history of fever, sore throat, abdominal pain, and vomiting. He was prescribed amoxicillin for suspected streptococcal pharyngitis, however, this was not tolerated due to severe vomiting. He was given an intramuscular (IM) injection of benzathine penicillin G in the right deltoid and subsequently developed arm pain and erythema (Figure  1). Due to worsening gangrenous changes and concern for compartment syndrome with loss of peripheral pulses, the patient underwent fasciotomy (Figure 2; available at
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Rediscovering the Physical Exam Source Type: research

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We present a unique case of Lemierre syndrome caused by Klebsiella pneumoniae, complicated by epidural abscess. The patient presented with fever, severe nuchal pain and stiffness and mild sore throat and headache. Computed tomography revealed a neck abscess localized dorsally to a left mandibular ramus and continuing caudally along the sternocleidomastoid muscle, thrombosis of the left internal jugular vein and fluid collection in the epidural space. Viewed under magnetic resonance imagining, the effusion had the character of an epidural abscess. Cultivation of oropharyngeal swab and blood cultures revealed Klebsiella pneu...
Source: IDCases - Category: Infectious Diseases Source Type: research
Abstract BACKGROUND: Postoperative sore throat is common after general anaesthesia. The incidence in paediatric anaesthesia is variable, and the aetiology unclear. Establishing risk-factors would enable prevention and could improve quality of care. AIMS: We performed a prospective single-centre cohort study aiming to establish the incidence of postoperative sore throat in children undergoing GA with an endotracheal tube or laryngeal mask airway. Secondary aims were to identify independent risk-factors for sore throat, and the incidence of other postoperative complications including stridor, laryngospasm, naus...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
ConclusionsHistorical ethnobotanical investigations could help to avoid creating repeating waves of popularity of plants that have already been tried for certain diseases and later abandoned as not fully effective. There is, of course, a chance that E. angustifolium could also finally be proven to be clinically safe and cost-effective for treating benign prostatic hyperplasia, but this has not yet happened despite recent intensive research. Documented traditional use would suggest investigating the dermatological, intestinal anti-hemorrhagic and pain inhibiting properties of this plant, if any.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Subcutaneous nodules present a diagnostic challenge, especially in critically ill patients with multiple comorbidities. This is a 56-year-old Caucasian female with sore throat and nausea admitted to the intensive care unit with acute renal failure from obstructive uropathy and urosepsis. She developed painful nodules on her lower extremities requiring dermatology consult. She acquired joint pain and swelling, and later developed abdominal pain and emesis. Physical exam revealed tender erythematous nodules on the thighs, shins and second and third digits of both feet without necrosis.
Source: Journal of the American Academy of Dermatology - Category: Dermatology Source Type: research
Updated Date: Aug 7, 2019 EST
Source: DailyMed Drug Label Updates - Category: Drugs & Pharmacology Source Type: alerts
I recently encountered an article that quantifies the resources expended by unnecessary patient visits to emergency departments (EDs) (see:Diverting avoidable emergency department visits could save healthcare $32 billion annually). Many such visits could have achieved the same results and less expensively in a physician's office. Below is an excerpt from the article:Diverting avoidable emergency department visits could save healthcare $32 billion annually. Primary care services rendered by hospital EDs come with substantially higher price tags than in primary care settings. Avoidable visits to emergency department...
Source: Lab Soft News - Category: Laboratory Medicine Authors: Tags: Cost of Healthcare Diagnostics Healthcare Information Technology Healthcare Innovations Hospital Financial Medical Consumerism Medical Education Preventive Medicine Public Health Quality of Care Source Type: blogs
This report presents a case of epiglottitis-related death occurring in a middle-aged diabetic man. He initially presented to an emergency department with complaints of a sore throat and bilateral ear pain. Although a quick test forStrep pneumoniae was negative, the work-up was not extensive enough to exclude epiglottitis. He was discharged with a prescription for a decongestant and instructed to drink plenty of fluids. He subsequently collapsed in respiratory distress while waiting to fill his prescription at a pharmacy. He was admitted to the hospital and eventually diagnosed with anoxic brain injury, dying 4  days f...
Source: Forensic Science, Medicine, and Pathology - Category: Forensic Medicine Source Type: research
Authors: Singh JR, Ibraheem K, Jain D, Yogendra K Abstract EBV associated nervous system complications includes encephalitis, meningitis, cerebellitis, polyradiculomyelitis, transverse myelitis, cranial and peripheral neuropathies, and psychiatric abnormalities are usually more commonly seen in immunocompromised patients and rarely in immunocompetent patients. Here we are reporting a 13 years old boy developed headache, malaise, sore throat and low back pain with radiation to both lower limbs. Next day he felt numbness below umbilicus followed by acute onset weakness in both lower limbs and urinary retention. Motor...
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
CONCLUSIONS: PACU patients suffer medium levels of discomfort, with pain and nonpain symptoms contributing nearly equally to it. In addition, multiple related characteristics were identified. PMID: 31255437 [PubMed - as supplied by publisher]
Source: Journal of Perianesthesia Nursing - Category: Nursing Authors: Tags: J Perianesth Nurs Source Type: research
A 9-year-old girl presented to the emergency department with bilateral hip pain. Eight days before onset, she had fever and sore throat that recovered spontaneously. On physical examination, tenderness of both hip joints was observed but no heart murmur. Body temperature was 36.8 °C. Blood tests showed elevated C-reactive protein (4.4 mg/dL) and antistreptolysin O titer (4540 IU/mL). Throat culture revealed Streptococcus pyogenes (M3 serotype [emm3.95 genotype] was isolated). A 12-lead standard electrocardiogram revealed a longer PR interval than that before onset (Figure  1, A and B).
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Insights and Images Source Type: research
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