A sore throat--potentially life-threatening?

A sore throat, which is most commonly viewed as a minor ailment, can be a manifestation of a life-threatening disorder known as Lemierre's syndrome caused by Fusobacterium necrophorum. We report a new case of Lemierre's syndrome that occurred in an otherwise healthy 18-year-old woman, who initially presented with fever and sore throat. The diagnosis was not made until a week later when blood cultures became available. This syndrome should be suspected until proven otherwise in any patient with signs of pharyngitis, a painful swollen neck, and pulmonary symptoms. By presenting this curable, but potentially life-threatening case of Lemierre's syndrome, we hope to increase the awareness of the early clinical manifestations of Lemierre's syndrome and to emphasize the importance of careful physical examination with special attention to the neck. Clinicians should be aware that exclusion of streptococcal infection in a patient with severe tonsillar infection does not exclude a bacterial cause.

Milk-alkali syndrome in a middle-aged woman after ingesting large doses of calcium carbonate: a case report.

INTRODUCTION: Most cases of hypercalcaemia are secondary to malignancy or primary hyperparathyroidism. Here we report a case of hypercalcaemia that we have attributed to milk-alkali syndrome. CASE PRESENTATION: A 51-year-old Caucasian woman with a past history of thyroidectomy and parathyroidectomy secondary to thyroid cancer developed an altered mental state and had an extremely high calcium concentration of 22.8 mg/dl (5.7 mmol/l). Investigations included work up for malignancy and hyperparathyroidism. However, the hypercalcaemia was attributed to ingestion of large doses of calcium carbonate, leading to milk-alkali syndrome. She was managed with intravenous fluids and withdrawal of calcium carbonate. The patient responded well to treatment, with normalization of the calcium concentration and clinical improvement. CONCLUSION: We present this case to remind clinicians of the importance of detailed history taking and of milk-alkali syndrome as a cause of hypercalcemia.