Lemierre's Syndrome: An Atypical Case of Fusobacterium necrophorum Bacteraemia in the Absence of Internal Jugular Vein Thrombosis.

Lemierre's syndrome primarily affects healthy adolescents and young adults as a complication of oropharyngeal infection, most commonly pharyngitis or peritonsillar abscess. Fusobacterium necrophorum is the principal pathogen, and the infection presents with classic symptoms including fever, sore throat, and neck tenderness. However, atypical presentations can pose diagnostic challenges. This report discusses a patient in her early 60s, contrary to the typical demographic, who presented with a one-week history of varied symptoms including sore throat, pleuritic chest pain, and haemoptysis. Examination revealed mild neck tenderness and lung crepitations. Laboratory tests indicated leucocytosis, thrombocytopenia, and elevated C-reactive protein (CRP). Imaging revealed pulmonary infiltrates with cavitation. F. necrophorum was detected in blood culture, promoting a CT scan of the neck, which confirmed soft tissue swelling and a small peritonsillar collection, leading to the diagnosis of Lemierre's syndrome. The classical feature of jugular vein thrombus was absent, further underscoring the atypical nature of this case. The patient received immediate initiation of intravenous antibiotics, piperacillin/tazobactam, followed by meropenem. This was complemented by a carefully tailored 21-day intravenous course, followed by an eight-week regimen of oral antibiotics consisting of amoxicillin and metronidazole. The patient demonstrated significant clinical improvement in pulmonary complications. Follow-up imaging showed minor residual changes, and the patient remained asymptomatic. Lemierre's syndrome presents a diagnostic challenge due to diverse clinical manifestations. Key diagnostic markers include deep neck infections, septicemia, and metastatic infections. Timely utilization of diagnostic tools, such as blood cultures and imaging, aid in confirmation. Early diagnosis is crucial for prompt treatment and prevention of complications. This case emphasizes the importance of maintaining a high index of suspicion for Lemierre's syndrome, especially in atypical presentations. Increased awareness among healthcare providers is vital for timely diagnosis and optimal patient outcomes.

Variations in origin level of superior mesenteric artery, inferior mesenteric artery, and coeliac trunk in Indian population.

OBJECTIVE: The abdominal aorta is a continuation of the thoracic aorta and gives off the coeliac trunk, superior mesenteric artery, and inferior mesenteric artery. The focus of our study is to evaluate variations in the origin level in the coeliac trunk, superior mesenteric artery, inferior mesenteric artery, and aortic bifurcation in the Indian population and compare with various demographics. METHODS: The study was retrospective and the local ethics committee approval was taken before starting it. Three hundred patients who were more than 18 years of age and required contrast-enhanced CT studies were included in this. The vertebral origin level of the arteries from the abdominal aorta and aortic bifurcation level was analysed. RESULTS: The most common origin level of the coeliac trunk for both males and females was T12-L1 disc level. The most common origin level of the superior mesenteric artery was L1 upper level. The most common origin level of the inferior mesenteric artery was L3 upper level. The most common level of aortic bifurcation was L4 middle level. There was no statistical difference between the origin of any arteries in males and females in the Indian population. CONCLUSION: As per our study of the Indian population and the published literature, it is realized that there are significant variations in the origins of the coeliac trunk, superior mesenteric artery, inferior mesenteric artery, and abdominal aorta bifurcation in different populations. ADVANCES IN KNOWLEDGE: This study elaborates on potential anatomical variations in the Indian population, particularly the Mumbai city population. Also, our study compares it to different countries' data and their results in variations found in abdominal aorta branches.

Determining the Normal Glenoid Version in the Indian Population.

Background Glenoid version refers to the angle subtended by the glenoid with the scapula. On average, it is 0 ± 10 degrees with a slight propensity toward retroversion. Numerous factors such the dominance(handedness), gender, ethnicity, and pathology are known to affect version. Version has important consequences on the biomechanics of the shoulder joint and is altered in those with arthritis and shoulder joint instability. Aim Our study aimed to determine the normal range of glenoid version in the population. Further, we aim to assess the relationship between gender and version. Settings and Design We conducted a retrospective observational study in a tertiary referral hospital with a target sample size of 200 shoulders. Methods and Materials The computed tomography images were retrospectively reviewed to determine the scapular shape and the glenoid version angle. Statistical Analysis Statistical analysis was done using SPSS v.22 software with p -value less than 0.05 considered as significant. Results The mean age of the individuals in our study was 44 years. In our study, irrespective of gender, most individuals had some degree of anteversion and males had lower degree of anteversion. Previous studies have shown that most normal individuals usually have retroverted shoulder joints. The mean glenoid version was significantly lower in the right than in the left shoulder and males had significantly lower mean glenoid version than females in both shoulders. Most individuals in our study had a flat scapular spine. Conclusion This study shows that the Indian population may have a slight propensity toward anteversion and this has an important bearing on shoulder arthroplasty. Further, this study shows that significantly lower degrees of version are found on the right side and that the degree of version is significantly lower in males. Understanding the role of glenoid version in shoulder biomechanics will go a long way in the early identification of pathology, the preoperative planning of shoulder arthroplasty, and the operative restoration of a functional shoulder joint.

A Previously Undiagnosed Case of Alkaptonuria in an 80-Year-Old Patient: A Case Report.

Alkaptonuria is a rare genetic metabolic disorder of autosomal recessive inheritance characterised by the accumulation of homogentisic acid in the body. It is diagnosed upon identification of characteristic symptoms, using various biochemical investigations, radiographic pictures, and a variety of specialised tests. Here we are discussing the case of an 80-year-old female patient with incidental findings of alkaptonuria. It is crucial to understand the fundamental diagnostic investigations that can be used in low-income nations or facilities where investigations like genetic testing, gas chromatography, and mass spectrometry are not readily available for the diagnosis of alkaptonuria.

CT and MRI Findings of Invasive Mucormycosis in the Setting of COVID-19: Experience From a Single Center in India.

An increasing incidence of rhinoorbitocerebral mucormycosis (ROCM) among patients with COVID-19 has recently been reported in India. We report the imaging findings for 25 patients with COVID-19 and invasive ROCM at a single hospital in India. Findings included sinus wall erosions (n = 20), air within bony sinus structures (n = 11), and focal mucosal nonenhancement (n = 8). Orbital, vascular, and intracranial complications were also observed. Radiologists should recognize the increasing incidence of ROCM among patients with COVID-19 to facilitate early diagnosis.