PMC9062341_01
Exudative pharyngitis is demonstrated 12 days prior to BMSCH admission.
gr1.jpg
PMC9062341_01_gr1.jpg
fig1
Physical exam was significant for erythema of the posterior pharynx with mild exudate (Fig. 1), anterior cervical lymphadenopathy, neck stiffness, decreased breath sounds at bases bilaterally, dullness on percussion of left lung area, and diffuse abdominal tenderness on deep palpation.
Image A is a plain film radiograph of the chest, which demonstrates a left sided pleural effusion (red arrow). Additionally, there are multiple airspace opacities (blue arrows) including cavitation in the left upper lobe. These findings are concerning for multifocal pneumonia with pleural effusion and cavitary necrosis. Images B (axial) and C (coronal) are CT scans of the neck with intravenous contrast which demonstrate enlargement of the right palatine tonsil with area of low attenuation centrally with mild peripheral rim enhancement with foci of air (green arrow). This represents a tonsillar abscess. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
gr2.jpg
PMC9062341_01_gr2.jpg
fig2
CT scan of the chest showed bilateral multifocal, necrotizing pneumonia, pleural effusions with loculations, cavitary abscess, left empyema, and mediastinal lymphadenopathy (Fig. 3). CT of neck showed right palatine tonsil and thyroid abscesses (Fig. 2).
Image A is an axial CT scan of the chest with intravenous contrast, which demonstrates bilateral pleural effusions (blue arrows) and bilateral pulmonary consolidations (purple arrows). Image B is an ultrasound of the chest, which shows bilateral hypoechoic pleural effusions with thick septations (red arrow) consistent with empyema. Image C is a coronal CT of the chest with intravenous contrast shows a cavitary left upper lobe mass (green arrow) concerning for cavitary/necrotizing pneumonia. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
gr3.jpg
PMC9062341_01_gr3.jpg
fig3
CT scan of the chest showed bilateral multifocal, necrotizing pneumonia, pleural effusions with loculations, cavitary abscess, left empyema, and mediastinal lymphadenopathy (Fig. 3). CT of neck showed right palatine tonsil and thyroid abscesses (Fig. 2).
Images A and B are sagittal CT scans of the spine in bone and lung windows which show foci of dark low attenuation (red arrow) within the T12 vertebral body, which are suspected to be air within the vertebral body and represent emphysematous osteomyelitis by a gas forming organism. Follow up MRI of the thoracic spine is shown. The T12 vertebral body has high signal intensity on T2 weighted imaging (not shown). Images C and D are sagittal images pre and post contrast T1 weighted images. There is heterogenous enhancement (blue arrow) of the vertebral body without significant enhancement of the adjacent disc spaces, consistent with osteomyelitis. There is an associated tiny epidural abscess. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
gr4.jpg
PMC9062341_01_gr4.jpg
fig4
The study revealed musculoskeletal edema and proximal humeral osteomyelitis and T12 vertebral body emphysematous osteomyelitis (Fig. 4) supporting hematogenous spread of infection.